Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort

BMC Infectious Diseases

Annemarie B. Docherty¹  Nazrul Islam²  Claire A. Lawson³  Clare L. Gillies⁴  Francesco Zaccardi⁴  Kamlesh Khunti⁵  Alex Rowlands⁶  Cameron Razieh⁶  Melanie J. Davies⁶  Thomas Yates⁶  Yogini Chudasama⁷  Malcolm G. Semple⁸  Peter J. M. Openshaw⁹  J. Kenneth Baillie^1,10 

[1] Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK;Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, UK;Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK;Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK;Diabetes Research Centre, Leicester General Hospital, University of Leicester, LE5 4PW, Leicester, UK;Diabetes Research Centre, Leicester General Hospital, University of Leicester, LE5 4PW, Leicester, UK;Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK;Diabetes Research Centre, Leicester General Hospital, University of Leicester, LE5 4PW, Leicester, UK;Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK;NIHR Applied Research Collaboration – East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK;Diabetes Research Centre, Leicester General Hospital, University of Leicester, LE5 4PW, Leicester, UK;National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, LE5 4PW, Leicester, UK;Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK;NIHR Health Protection Research Unit in Emerging and Zoonotic Infections and Institute of Translational Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK;Respiratory Medicine, Alder Hey Children’s Hospital, Institute in The Park, University of Liverpool, Alder Hey Children’s Hospital, L12 2AP, Liverpool, UK;National Heart and Lung Institute, Imperial College London, London, UK;Roslin Institute, University of Edinburgh, Edinburgh, UK;

关键词: Obesity;    Chronic disease;    Ageing;    COVID-19;   

DOI  :  10.1186/s12879-021-06466-0

来源: Springer

【 摘 要 】

BackgroundAlthough age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched.MethodsWe used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories.ResultsThe analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease.ConclusionObesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making.

【 授权许可】

CC BY