Obesity Is One of the Strongest Risk Factor for Respiratory Failure and Death in COVID-19 Patients: A Retrospective Multicentric Cohort Study

Background A significant spread of Coronavirus Disease 19 (COVID-19) has been observed in Western countries. The aim of the study was to analyze whether obesity (BMI ≥ 30 kg/m2) was a risk factor for respiratory failure and death. Methods Retrospective multicentric cohort study of 296 COVID-19 patients admitted to the hospital between February 28 and March 28, 2020. Demographic characteristics, laboratory findings and clinical scores were compared in obese and non-obese patients. Multivariable analysis was carried out to identify the risk factors for respiratory failure and mortality. Findings Of 296 patients, 70 (23·6%) had a BMI ≥ 30 kg/m2. Obese patients were significantly older (68±13·5 vs. 63±16·8, p=0·0052) and reported a higher rate of hypertension (77.9% vs. 40.2%, p<0.0001), chronic obstructive pulmonary disease (COPD) (24·3% vs. 9·7%, p=0·0017), type 2 diabetes (18·6% vs. 9·3%, p=0·033) and moderate/severe renal disease (12·9% vs. 2·7%, p=0·0007). Obese patients were more likely to require continuous positive airway pressure (20% vs. 7·8%, p=0·0052), non-invasive ventilation (20% vs. 7·5%, p=0·0061) and intensive care admission (40% vs. 15·9%, p<0·0001). At multivariable analysis, age and obesity were the only significant risk factors for the onset of respiratory failure (odds ratio [OR] 1·04, p<0·0001; OR 3·16, p=0·001) and mortality (OR 1·10, p<0.0001; OR 3·11, p=0·008). Interpretation Obesity is the strongest risk factor for respiratory failure and death among COVID-19 patients. Taking into account the high prevalence of obesity in the Western countries, prompt evaluation and aggressive treatment are advisable in obese patients.