Scientific letter
Relationship between obesity, diabetes and ICU admission in COVID-19 patients
Relación entre obesidad, diabetes e ingreso en UCI en pacientes COVID-19
Laura Fernández García
, Ana Belén Puentes Gutiérrez, María García Bascones
Corresponding author
Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario de Toledo, Toledo, Spain
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The homogeneity of the sample is observed, with little dispersion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Based on initial evidence about this pandemic, the older population and/or those with associated chronic pathology (high blood pressure, diabetes, obesity…) have been identified as being more likely to develop more severe clinical forms of the infection. Obesity as a risk factor and predictor of COVID-19 infection severity is being reported by some studies, but there is still a great lack of evidence. Even so, it has been postulated as an independent risk factor for COVID-19 since it was recognized as such during the 2009 H1N1 pandemic. Our objective is to study the relationship between obesity, the need for oxygen therapy with a reservoir (non-rebreather) mask, and the need for ICU, as well as to analyse the cardiovascular profile of patients who have required hospital admission for COVID-19 pneumonia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective and descriptive cohort study of 49 consecutive patients admitted to the Internal Medicine hospital ward for COVID-19 infection at the Toledo Hospital Complex was conducted from 23rd March to 14th April 2020. Variables were collected on cardiovascular disease, need for a reservoir (non-rebreather) mask and admission to the ICU. According to the body mass index (BMI), overweight was defined for values from 25.0 to 29.9 kg/m<span class="elsevierStyleSup">2</span> and obesity for BMI >30.0 kg/m<span class="elsevierStyleSup">2</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">57.14% were male, the mean age was 60.30 years (SD 11.88) and the mean BMI of 28.40 kg/m<span class="elsevierStyleSup">2</span> (SD 3.34). 59.2% were overweight and 24.5% were obese. The prevalence of hypertension was 48.98%, that of dyslipidaemia was 38.78% and that of diabetes mellitus was 18.37%. 38.78% required a mask with a reservoir and 28.57% were admitted to the ICU. The mean BMI of the patients who required a reservoir mask was 28.74 kg/m<span class="elsevierStyleSup">2</span> (SD 3,169), compared to 28.19 kg/m<span class="elsevierStyleSup">2</span> (SD 3.493) in those who did not need it, resulting in a difference of 0.98, with a CI 95% between ↓2.54 and 1.43. Regarding the patients who required admission to the ICU, a mean BMI of 28.16 kg/m<span class="elsevierStyleSup">2</span> (SD 3,240) was obtained, compared to 28.50 kg/m<span class="elsevierStyleSup">2</span> (SD 3.432) of those who did not require one, resulting in a difference of 1.06, with a  95% CI between ↓1.80 and 2.49. No statistically significant relationship was obtained between the need for a reservoir mask and the variables BMI, hypertension, dyslipidaemia, and diabetes. Regarding the need for admission to the ICU, its association was statistically significant with diabetes mellitus (p = 0.037), but not with the rest of the variables analysed (multivariate analysis).</p><p id="par0020" class="elsevierStylePara elsevierViewall">According to the literature, higher mortality has been observed in a diabetic population with COVID-19 over 65 years of age. The largest study reported from China (72,314 cases) showed an increased incidence of mortality in diabetic patients with COVID-19 (2.3% over 7.3%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Our study also found a significant relationship between diabetes and the need for admission to the ICU. Regarding obesity, several studies carried out in China, Italy and the United States have demonstrated that this population is more likely to be infected by the virus and more likely to develop more serious pneumonia, complications and death, as well as a greater risk of developing a more virulent strain and prolonging the time of infection to the rest of the population.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Similar data have been obtained in France, demonstrating that a BMI ≥35 kg/m<span class="elsevierStyleSup">2</span> is an independent factor of severity in COVID-19 infection.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, there are conflicting results on obesity. Our sample did not show a greater need for oxygen therapy with a reservoir mask nor a greater need for ICU admission for subjects with a higher BMI, in accordance with studies such as those by Li et al. and Qingxian et al., that do not establish a link between obesity and the severity of COVID-19 pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> A limitation of this study is the high prevalence of overweight in the population under study, which provides us with a very homogeneous sample with little dispersion (BMI 28.40 kg/m<span class="elsevierStyleSup">2</span> [SD 3.34]) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and that can lead to contradictory findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, this study has not been able to establish obesity as a factor influencing COVID-19 infection, in terms of requiring admission to the ICU and/or the need for oxygen therapy supplementation with a reservoir (non-rebreather) mask, but an association between diabetes and admission to the ICU has been demonstrated.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, the commercial sector, or non-profit organisations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:2 [ "identificador" => "xack485049" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández García L, Puentes Gutiérrez AB, García Bascones M. Relación entre obesidad, diabetes e ingreso en UCI en pacientes COVID-19. Med Clin (Barc). 2020;155:314–315.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 829 "Ancho" => 1507 "Tamanyo" => 80613 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dispersion table of BMI and age variables in the sample. The homogeneity of the sample is observed, with little dispersion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z. Wu" 1 => "J.M. McGoogan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2020.2648" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2020" "volumen" => "323" "paginaInicial" => "1239" "paginaFinal" => "1242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32091533" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Luzi" 1 => "M.G. 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Duhamel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/oby.22831" "Revista" => array:3 [ "tituloSerie" => "Obesity" "fecha" => "2020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15917845" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Qingxian Cai, Fengjuan Chen, Luo Fang, Liu Xiaohui, Tao Wang, Wu Qikai, et al. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. JAMA. Available from: <a target="_blank" href="https://ssrn.com/abstract=3556658">https://ssrn.com/abstract=3556658</a><a target="_blank" href="https://doi.org/10.2139/ssrn.3556658">https://doi.org/10.2139/ssrn.3556658</a>." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Li" 1 => "S. Xu" 2 => "M. Yu" 3 => "K. Wang" 4 => "Y. Tao" 5 => "Y. 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Puentes Gutiérrez for their methodological support.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000007/v1_202010060722/S2387020620304228/v1_202010060722/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000007/v1_202010060722/S2387020620304228/v1_202010060722/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620304228?idApp=UINPBA00004N" ]
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| 2020 December | 18 | 7 | 25 |
| 2020 November | 28 | 4 | 32 |
| 2020 October | 16 | 5 | 21 |
| 2020 September | 1 | 12 | 13 |
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