Obesity Paradox: Does It Lengthen Survival in Iranian COVID Patients?

A prominent issue for patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is obesity. Some reports claim that obese patients with acute respiratory distress syndrome have better outcomes. This inverse relationship has been termed the obesity paradox and is not yet understood in patients with coronavirus disease 2019 (COVID-19) hospitalized in the intensive care unit (ICU). The aim of this study was to investigate the obesity paradox in patients with COVID-19 admitted to the ICU. In this retrospective observational study, 5230 patients with COVID-19, admitted to the ICU between June 1, 2020, and January 10, 2021, were analyzed. Body mass index (BMI) was calculated according to the World Health Organization classification, and patients were categorized as underweight, normal, overweight, or obese for statistical analysis. A Kaplan-Meier survival analysis, Cox regression model, and dose-response relationship between BMI level and ICU length of stay (LOS) and connection to the ventilator survival were conducted. Of the 5230 patients studied, 3233 (62%) had nonobese BMIs, and 2997 (38%) were obese. We found no significant difference in mortality between obese and nonobese patients with COVID-19, where 1699 patients (31%) survived. However, there were significant differences in BMI level for ICU LOS and ventilation duration (P < 0.05, P < 0.03). In multivariable Cox regression, significant differences were observed in ICU LOS and ventilation duration of patients between obese and nonobese patients (P < 0.001, P < 0.005). There was no association between BMI and survival among patients with LOS in the ICU LOS or connection to a ventilator. However, obese patients with COVID-19 require more care than nonobese patients because of additional comorbidities, higher inflammation, and a weaker immune system.