Key result
BMI ≥40 kg/m2 linked to ~49% lower two-year mortality vs normal BMI in critical COVID-19.
Why the study?
The impact of obesity on long-term survival after intensive care unit admission with severe COVID-19 was unclear.
Does a BMI ≥40 kg/m2 improve survival time up to two years in patients admitted to the ICU with severe COVID-19 compared to a BMI of 18.5-24.9 kg/m2?
Cohort (n=2,931)
Yes
Does a BMI ≥40 kg/m2 improve survival time up to two years in patients admitted to the ICU with severe COVID-19 compared to a BMI of 18.5-24.9 kg/m2?
An obesity paradox exists in critically ill COVID-19 patients, where a BMI ≥40 kg/m2 is associated with improved survival up to two years post-ICU admission.
May extend obesity paradox to 2-year COVID-19 ICU survival; hypothesis-generating and should not yet change practice.
The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe coronavirus disease 2019 (COVID-19) is unclear. We aimed to quantify the impact of obesity on time to death up to two years in patients admitted to Australian and New Zealand ICUs. Retrospective multicentre study. 92 ICUs between 1st January 2020 through to 31st December 2020 in New Zealand and 31st March 2022 in Australia with COVID-19, reported in the Australian and New Zealand Intensive Care Society adult patient database. All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the World Health Organization recommendations. The primary outcome was survival time up to two years after ICU admission. The effect of obesity on time to death was assessed using a Cox proportional hazards model. Confounders were acute illness severity, sex, frailty, hospital type and jurisdiction for all patients. We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6–36.0) kg/m 2 . Patients with a BMI ≥30 kg/m 2 were younger (median [IQR] age 57.7 [46.2–69.0] vs. 63.0 [50.0–73.6]; p < 0.001) than those with a BMI <30 kg/m 2 . Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5 kg/m 2 (35.4%) and 18.5–24.9 kg/m 2 (31.1%), while lowest for BMI ≥40 kg/m 2 (14.5%). After adjusting for confounders and with BMI 18.5–24.9 kg/m 2 category as a reference, only the BMI ≥40 kg/m 2 category patients had improved survival up to 2 years (hazard ratio = 0.51; 95%CI: 0.34–0.76). The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40 kg/m 2 was associated with a higher survival time of up to two years.
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Subramaniam et al. (2023) conducted a cohort in severe COVID-19 (n=2,931). BMI ≥40 kg/m2 vs. BMI 18.5–24.9 kg/m2 was evaluated on survival time up to two years after ICU admission (HR 0.51, 95% CI 0.34-0.76). In critically ill patients with COVID-19, a BMI ≥40 kg/m2 was associated with improved survival up to two years compared to a BMI of 18.5–24.9 kg/m2 (HR 0.51; 95% CI 0.34–0.76).
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