Inflammation does not cause death in obese people with COVID-19

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Several studies suggest those who are overweight or have obesity are more likely to experience invasive mechanical ventilation, intensive care unit (ICU) admission, or death.

They also suggest a higher COVID-19 mortality rate in countries with a greater prevalence of obesity.

But in a recent study at Boston Medical Center, researchers found that this is not due to increased inflammation (the so-called cytokine storm of COVID), but instead may be driven by respiratory issues or other factors.

The study is published in PLOS ONE. One author of the study is Ana Mostaghim, M.D.

In the study, the researchers compared outcomes and inflammatory markers in patients with and without obesity who were hospitalized with COVID-19.

They found that body mass index (BMI) greater or equal to 35 was linked to a two-fold increased risk of ICU transfer and a four-fold risk of death risk.

BMI in the 30-34.9 range (Class I obesity) was also linked to increased risk of ICU transfer, but not strongly linked to increased death risk.

The team also found that patients with obesity had mostly lower inflammatory markers on the first and second hospital days compared to those without obesity.

According to the researchers, additional factors may explain the unexpected finding of lower inflammatory markers in patients with obesity.

These patients may have other risk factors (type-2 diabetes, high blood pressure and coronary artery disease) for poor outcomes in COVID-19, conditions that are inflammatory and immune-mediated.

The team says while patients with obesity had worse clinical outcomes than those without obesity in the study, this effect does not appear to be mediated by a higher degree of inflammation.

Patients with obesity are at higher risk of fatty liver disease and greater viral invasion with organ dysfunction may contribute to the increased mortality seen in these patients.

Alternately, patients with obesity may have reduced respiratory reserve.

Further studies are needed to determine whether this decreased inflammatory response persists during hospitalization, whether pro-inflammatory complications are seen less common among patients with obesity and whether anti-inflammatory therapy should be utilized differently in patients with obesity.

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