Cargando…
Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort
BACKGROUND: Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. METHODS: We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the Inter...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324452/ https://www.ncbi.nlm.nih.gov/pubmed/34330226 http://dx.doi.org/10.1186/s12879-021-06466-0 |
_version_ | 1783731400441069568 |
---|---|
author | Yates, Thomas Zaccardi, Francesco Islam, Nazrul Razieh, Cameron Gillies, Clare L. Lawson, Claire A. Chudasama, Yogini Rowlands, Alex Davies, Melanie J. Docherty, Annemarie B. Openshaw, Peter J. M. Baillie, J. Kenneth Semple, Malcolm G. Khunti, Kamlesh |
author_facet | Yates, Thomas Zaccardi, Francesco Islam, Nazrul Razieh, Cameron Gillies, Clare L. Lawson, Claire A. Chudasama, Yogini Rowlands, Alex Davies, Melanie J. Docherty, Annemarie B. Openshaw, Peter J. M. Baillie, J. Kenneth Semple, Malcolm G. Khunti, Kamlesh |
author_sort | Yates, Thomas |
collection | PubMed |
description | BACKGROUND: Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. METHODS: We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories. RESULTS: The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease. CONCLUSION: Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06466-0. |
format | Online Article Text |
id | pubmed-8324452 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-83244522021-08-02 Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort Yates, Thomas Zaccardi, Francesco Islam, Nazrul Razieh, Cameron Gillies, Clare L. Lawson, Claire A. Chudasama, Yogini Rowlands, Alex Davies, Melanie J. Docherty, Annemarie B. Openshaw, Peter J. M. Baillie, J. Kenneth Semple, Malcolm G. Khunti, Kamlesh BMC Infect Dis Research BACKGROUND: Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. METHODS: We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC). Patients admitted to hospital with COVID-19 from 6th February to 12th October 2020 were included where there was a coded outcome following hospital admission. Obesity was determined by an assessment from a clinician and chronic disease by medical records. Chronic diseases included: chronic cardiac disease, hypertension, chronic kidney disease, chronic pulmonary disease, diabetes and cancer. Mutually exclusive categories of obesity, with or without chronic disease, were created. Associations with in-hospital mortality were examined across sex and age categories. RESULTS: The analysis included 27,624 women with 6407 (23.2%) in-hospital deaths and 35,065 men with 10,001 (28.5%) in-hospital deaths. The prevalence of chronic disease in women and men was 66.3 and 68.5%, respectively, while that of obesity was 12.9 and 11.1%, respectively. Association of obesity and chronic disease status varied by age (p < 0.001). Under 50 years of age, obesity and chronic disease were associated with in-hospital mortality within 28 days of admission in a dose-response manner, such that patients with both obesity and chronic disease had the highest risk with a hazard ratio (HR) of in-hospital mortality of 2.99 (95% CI: 2.12, 4.21) in men and 2.16 (1.42, 3.26) in women compared to patients without obesity or chronic disease. Between the ages of 50–69 years, obesity and chronic disease remained associated with in-hospital COVID-19 mortality, but survival in those with obesity was similar to those with and without prevalent chronic disease. Beyond the age of 70 years in men and 80 years in women there was no meaningful difference between those with and without obesity and/or chronic disease. CONCLUSION: Obesity and chronic disease are important risk factors for in-hospital mortality in younger age groups, with the combination of chronic disease and obesity being particularly important in those under 50 years of age. These findings have implications for targeted public health interventions, vaccination strategies and in-hospital clinical decision making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06466-0. BioMed Central 2021-07-31 /pmc/articles/PMC8324452/ /pubmed/34330226 http://dx.doi.org/10.1186/s12879-021-06466-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Yates, Thomas Zaccardi, Francesco Islam, Nazrul Razieh, Cameron Gillies, Clare L. Lawson, Claire A. Chudasama, Yogini Rowlands, Alex Davies, Melanie J. Docherty, Annemarie B. Openshaw, Peter J. M. Baillie, J. Kenneth Semple, Malcolm G. Khunti, Kamlesh Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title | Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_full | Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_fullStr | Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_full_unstemmed | Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_short | Obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of ISARIC clinical characterisation protocol UK cohort |
title_sort | obesity, chronic disease, age, and in-hospital mortality in patients with covid-19: analysis of isaric clinical characterisation protocol uk cohort |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8324452/ https://www.ncbi.nlm.nih.gov/pubmed/34330226 http://dx.doi.org/10.1186/s12879-021-06466-0 |
work_keys_str_mv | AT yatesthomas obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT zaccardifrancesco obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT islamnazrul obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT raziehcameron obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT gilliesclarel obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT lawsonclairea obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT chudasamayogini obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT rowlandsalex obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT daviesmelaniej obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT dochertyannemarieb obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT openshawpeterjm obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT bailliejkenneth obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT semplemalcolmg obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort AT khuntikamlesh obesitychronicdiseaseageandinhospitalmortalityinpatientswithcovid19analysisofisaricclinicalcharacterisationprotocolukcohort |