Kidney Week

Abstract: FR-PO1128

Association of Body Mass Index with Multiple Organ Failure in Hospitalized Adults with COVID-19

Session Information

• COVID-19 - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Coronavirus (COVID-19)

• 000 Coronavirus (COVID-19)

Authors

• Phillips, Timothy Hyland, St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Timothy Hyland Phillips,

• Mughrabi, Abdallah, St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Abdallah Mughrabi,

• Garcia Quarto, Levindo Jose, St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Levindo Jose Garcia Quarto,

• El Mouhayyar, Christopher, St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Christopher El Mouhayyar,

• Hattar, Laith, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States

Laith Hattar,

• Tighiouart, Hocine, Tufts University School of Medicine, Boston, Massachusetts, United States

Hocine Tighiouart,

• Moraco, Andrew H., St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Andrew H. Moraco,

• Nader, Claudia, St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Claudia Nader,

• Jaber, Bertrand L., St. Elizabeth's Medical Center, Boston, Massachusetts, United States

Bertrand L. Jaber,

Background

Patients with severe coronavirus disease 2019 (COVID-19) experience an excessive cytokine release syndrome, which promotes an increased risk of acute organ dysfunction and death. The aim of our study was to examine whether excessive adipose tissue, as measured by body mass index (BMI), is associated with higher systemic markers of inflammation and higher risk of severe acute organ failure or in-hospital death among hospitalized patients with COVID-19.

Methods

1370 hospitalized adults (18 years or older) with COVID-19 during the first wave of the pandemic in Massachusetts (March 1, 2020, to July 31, 2020) met inclusion criteria. Our primary outcome was the composite of severe acute kidney injury (AKI), as defined by acute dialysis requirement, severe acute lung injury (ALI), as defined by use of high-flow nasal canula, non-invasive ventilation, or mechanical ventilation, or in-hospital death. Secondary endpoints of interest included the association of BMI with serum peak CRP level, a systemic marker of inflammation.

Results

After adjustment for age, gender, race, Charlson Comorbidity Index (CCI), baseline eGFR, and the NIH clinical spectrum of SARS-CoV-2 infection, the highest BMI stratum of > 40 kg/m² (compared to the BMI <25 kg/m² reference group) was associated with higher odds for the composite of severe AKI, severe ALI, or in-hospital death (adjusted odds ratio [OR_adj] 1.69; 95% CI 1.03, 2.78), and the composite of severe ALI or in-hospital death (OR_adj 1.69; 95% CI 1.03, 2.77). As a continuous variable, BMI (per 5-kg/m² increase) remained independently associated with these outcomes. Interestingly, this association was no longer significant after adjustment for peak CRP level.

Conclusion

Among hospitalized adult with COVID-19, higher BMI associates with higher risk of severe organ failure or death, which dissipates after adjustment for CRP level. This supports the hypothesis that inflammation is a downstream mediator of the adipose tissue on acute organ dysfunction, possibly through dysregulated immune responses. More research is needed to understand this association in COVID-19.

Funding

• Other NIH Support