University of Leicester
Browse
Obesity, chronic disease, age, and in hospital mortality in patients with covid 19 analysis of ISARIC clinical characterisation protocol UK cohort.pdf (1.23 MB)

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

Download (1.23 MB)
journal contribution
posted on 2021-12-03, 11:50 authored by Thomas Yates, Francesco Zaccardi, Nazrul Islam, Cameron Razieh, Clare L Gillies, Claire A Lawson, Yogini Chudasama, Alex Rowlands, Melanie J Davies, Annemarie B Docherty, Peter JM Openshaw, J Kenneth Baillie, Malcolm G Semple, Kamlesh Khunti
Background
Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched.

Methods
We 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.

Results
The 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.

Conclusion
Obesity 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.

Funding

This work was supported by the NIHR Leicester BRC, NIHR ARC-EM and a grant from the UKRI-DHSC COVID-19 Rapid Response Rolling Call (MR/V020536/1), the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool.

History

Citation

BMC Infect Dis 21, 717 (2021). https://doi.org/10.1186/s12879-021-06466-0

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

  • VoR (Version of Record)

Published in

BMC INFECTIOUS DISEASES

Volume

21

Issue

1

Publisher

BMC

issn

1471-2334

eissn

1471-2334

Acceptance date

2021-07-19

Copyright date

2021

Available date

2021-12-03

Spatial coverage

England

Language

English

Usage metrics

    University of Leicester Publications

    Categories

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC