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Disclosures: The authors report no relevant financial disclosures.
October 30, 2020
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Obesity associated with increased odds of acute renal failure, shock in COVID-19

Disclosures: The authors report no relevant financial disclosures.
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Adults with obesity who died of COVID-19 in Italy were more likely to experience nonrespiratory complications such as acute renal failure and shock than those without obesity, with higher odds for those younger than 60 years, according to study data.

“Obesity, in addition to the known effect on COVID-19 respiratory complications, is associated with an increased probability of nonrespiratory deaths,” Graziano Onder, MD, PhD, a professor in the department of cardiovascular, endocrine-metabolic diseases and aging at the Istituto Superiore di Sanità in Rome, and colleagues wrote in a study published in Obesity. “Obesity is a known risk factor for increased susceptibility to infections, sepsis and infection-related mortality, and this increased risk has been attributed to the state of chronic, low-grade inflammation that characterizes this condition.”

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Onder and colleagues collected COVID-19 case medical chart data from all 19 regions and two autonomous provinces in Italy. A surveillance system was used to track deaths among individuals with confirmed COVID-19. The number of individuals experiencing acute distress respiratory syndrome, acute renal failure, shock, superinfection and myocardial infarction was recorded.

Researchers included data on 3,694 people who died of COVID-19 in Italy through July 9. Among the cohort, 11.1% had obesity. When compared with those who died without obesity, individuals with obesity were more likely to experience acute renal failure (adjusted OR = 1.33; 95% CI, 1.04-1.71) and shock (aOR = 1.54; 95% CI, 1.19-1.99).

Obesity was also associated with age in COVID-19 deaths. Adults with obesity who were younger than 60 years had double the odds of experiencing acute renal failure (aOR = 2; 95% CI, 1.09-3.67) or shock (aOR = 2.37; 95% CI, 1.29-4.36) compared with those without obesity. Individuals aged at least 60 years with obesity still had an elevated likelihood of acute renal failure (aOR = 1.2; 95% CI, 0.9-1.6) and shock (aOR = 1.22; 95% CI, 0.91-1.65) compared with people without obesity, although the ORs were lower than for younger adults.

“The association of obesity with nonrespiratory complications, namely, acute renal failure and shock, is stronger in younger than in older adults,” the researchers wrote. “This finding confirms previous observations that suggested an obesity paradox in older persons with COVID-19, in which higher BMI is associated with better outcomes when SARS-CoV-2 infection occurs.”

Men with obesity also had higher ORs for acute renal failure (OR = 1.36; 95% CI, 1-1.84) and shock (OR = 1.7; 95% CI, 1.24-2.34) than women with obesity who experienced acute renal failure (OR = 1.24; 95% CI, 0.79-1.96) or shock (OR = 1.13; 95% CI, 0.7-1.8).

“We show that in patients dying with COVID-19 in Italy, obesity is associated with an increased probability of nonrespiratory complications, particularly shock and acute renal failure,” the researchers wrote. “This association is more pronounced in men and young adults. Strategies should be put in place in patients with these characteristics to prevent COVID-19 complications.”