TY - JOUR
T1 - Body mass index and critical care outcomes in hospitalized COVID-19 patients-A national cohort study
AU - Bonilla, Yolanda
AU - High, Daniel
AU - Acosta Rullan, Jose
AU - Tabba, Jude
AU - Shalmiyev, Richard
AU - Noris, Tanner
AU - Folds, Andrea
AU - Martinez, Ana
AU - Heller, Daniel
AU - Diaz, Raiko
AU - Kathuria, Siddarth
AU - Sharma, Prerna
AU - Danckers, Mauricio
N1 - Copyright: © 2025 Bonilla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025
Y1 - 2025
N2 - BACKGROUND: The COVID-19 pandemic caused significant global mortality. Obesity is associated with worse COVID-19 outcomes. This study examined the relationship between BMI, clinical interventions, and outcomes in hospitalized COVID-19 patients using pre-vaccine national data.METHODS: We conducted a retrospective cohort study using de-identified electronic health records from the HCA Healthcare database, comprising 149 hospitals across 18 U.S. states. Adults (≥18 years) hospitalized with confirmed SARS-CoV-2 infection between March 1 and December 31, 2022, were included. The primary outcome was a composite of in-hospital mortality or discharge to hospice, analyzed by BMI category. Secondary outcomes included inpatient mortality, need for mechanical ventilation or tracheostomy, duration of mechanical ventilation, and ICU (Intensive Care Unit) length of stay.RESULTS: Out of 38,321 hospital encounters, 21,996 met the inclusion criteria. Unadjusted analyses showed no significant differences in rates of all-cause mortality or hospice discharge across BMI categories. However, obese patients had higher rates of mechanical ventilation (7.8% vs. 4.6%, p < 0.001), tracheostomy placement (1.2% vs. 0.6%, p < 0.001), longer duration of mechanical ventilation (mean 11.5 ± 15.1 vs. 6.8 ± 8.7 days, p < 0.001), and longer ICU stays (8.3 ± 10.4 vs. 5.1 ± 6.4 days, p < 0.001) than normal BMI patients. In adjusted analyses controlling for age, sex, race, ethnicity, and comorbidities, obesity was independently associated with increased odds of all-cause mortality or hospice discharge (OR 1.29, 95% CI: 1.08-1.55, p < 0.05), inpatient mortality (OR 1.67, 95% CI: 1.34-2.08, p < 0.001), need for invasive mechanical ventilation (OR 1.55, 95% CI: 1.31-1.82, p < 0.001), and tracheostomy placement (OR 1.57, 95% CI: 1.03-2.41, p < 0.05). Obesity was a significant predictor of longer duration of mechanical ventilation (β = 3.67 days, 95% CI: 1.28-6.06, p < 0.001) and ICU stay (β = 2.90 days, 95% CI: 2.08-3.72, p < 0.001).CONCLUSION: Obesity was independently associated with increased risk of adverse clinical outcomes among hospitalized COVID-19 patients. These findings highlight the importance of BMI as a prognostic factor in acute COVID-19 management.
AB - BACKGROUND: The COVID-19 pandemic caused significant global mortality. Obesity is associated with worse COVID-19 outcomes. This study examined the relationship between BMI, clinical interventions, and outcomes in hospitalized COVID-19 patients using pre-vaccine national data.METHODS: We conducted a retrospective cohort study using de-identified electronic health records from the HCA Healthcare database, comprising 149 hospitals across 18 U.S. states. Adults (≥18 years) hospitalized with confirmed SARS-CoV-2 infection between March 1 and December 31, 2022, were included. The primary outcome was a composite of in-hospital mortality or discharge to hospice, analyzed by BMI category. Secondary outcomes included inpatient mortality, need for mechanical ventilation or tracheostomy, duration of mechanical ventilation, and ICU (Intensive Care Unit) length of stay.RESULTS: Out of 38,321 hospital encounters, 21,996 met the inclusion criteria. Unadjusted analyses showed no significant differences in rates of all-cause mortality or hospice discharge across BMI categories. However, obese patients had higher rates of mechanical ventilation (7.8% vs. 4.6%, p < 0.001), tracheostomy placement (1.2% vs. 0.6%, p < 0.001), longer duration of mechanical ventilation (mean 11.5 ± 15.1 vs. 6.8 ± 8.7 days, p < 0.001), and longer ICU stays (8.3 ± 10.4 vs. 5.1 ± 6.4 days, p < 0.001) than normal BMI patients. In adjusted analyses controlling for age, sex, race, ethnicity, and comorbidities, obesity was independently associated with increased odds of all-cause mortality or hospice discharge (OR 1.29, 95% CI: 1.08-1.55, p < 0.05), inpatient mortality (OR 1.67, 95% CI: 1.34-2.08, p < 0.001), need for invasive mechanical ventilation (OR 1.55, 95% CI: 1.31-1.82, p < 0.001), and tracheostomy placement (OR 1.57, 95% CI: 1.03-2.41, p < 0.05). Obesity was a significant predictor of longer duration of mechanical ventilation (β = 3.67 days, 95% CI: 1.28-6.06, p < 0.001) and ICU stay (β = 2.90 days, 95% CI: 2.08-3.72, p < 0.001).CONCLUSION: Obesity was independently associated with increased risk of adverse clinical outcomes among hospitalized COVID-19 patients. These findings highlight the importance of BMI as a prognostic factor in acute COVID-19 management.
KW - Humans
KW - COVID-19/mortality
KW - Male
KW - Female
KW - Body Mass Index
KW - Middle Aged
KW - Retrospective Studies
KW - Aged
KW - Hospital Mortality
KW - Respiration, Artificial/statistics & numerical data
KW - Obesity/complications
KW - United States/epidemiology
KW - Length of Stay
KW - Adult
KW - SARS-CoV-2/isolation & purification
KW - Intensive Care Units
KW - Hospitalization
KW - Critical Care Outcomes
KW - Critical Care
KW - Tracheostomy
U2 - 10.1371/journal.pone.0329779
DO - 10.1371/journal.pone.0329779
M3 - Article
C2 - 40828810
SN - 1932-6203
VL - 20
SP - e0329779
JO - PloS one
JF - PloS one
IS - 8
ER -