COVID-19 Patients with Obesity Have Lower Inflammatory Biomarkers, Study Finds

Patients with overweight and obesity who are infected with COVID-19 have lower levels of COVID-19-related inflammatory markers than normal weight patients, according to an abstract presented at the virtual ObesityWeek® 2020 Interactive meeting this week. 

Study authors, led by Claire Le Guen, MD, of Temple University Hospital, in Philadelphia, also found obese, severely obese, and morbidly obese patients are younger and more likely to present for care with respiratory symptoms.

Le Guen and colleagues set out with the current understanding of COVID-19 as an acute pulmonary infection that can progress in severity to cytokine storm syndrome as a result of pervasive dysregulated inflammatory response. Patients with obesity seem particularly vulnerable to this response given the hyperinflammatory nature of the disease. The aim of the study was to further describe the inflammatory profile of patients with obesity and to correlate obesity with other characteristics of virus presentation.

Patients were a retrospective cohort with confirmed COVID-19 infection admitted to the Temple Healthcare system between March and May 2020. Patients were stratified by World Health Organization (WHO) obesity classification; presenting symptoms, disease biomarkers, demographics and outcomes were investigated.

• Age was found to be inversely related to the obesity class (p<.001)
• Patients with increasing obesity class presented with more initial symptoms of shortness of breath (p<0.013) as well as cough (p<0.027).
• Initial D-dimer and ferritin lab values were negatively correlated with increasing obesity class (D-dimer, p<.015; ferritin, p<.0001).
• A normal or near-normal lymphocyte profile was noted in patients with obesity compared to patients without obesity (Lymphocyte %: 16.8, 16.9, 19.7, 19.7, 20.9; p 0.004).
• There were no significant differences observed in outcomes of intubation rate (p=0.589), ICU admission (p=0.594), or mortality (p=0.331) across BMI classes
  

Conclusion

The authors state that patients with obesity were younger and more likely to present to the hospital with respiratory symptoms. They also had reduced levels of COVID-19-related markers of systemic inflammation--an unexpected finding given the association of obesity with baseline hyperinflammation.

Moreover, despite the lower level of inflammatory markers, outcomes among patients with obesity for ICU admission and intubation and even for mortality were comparable to those of non=obese patients with more severe inflammatory profiles.

Given that inflammatory biomarkers are used to guide treatment of patients hospitalized with severe COVID-19 infection, the authors point to the need for further investigation of treatment choice and associated outcomes in this population.