Association of BMI and Obesity with Composite poor outcome in COVID-19 adult patients: A Systematic Review and Meta-Analysis

Aim: This study aimed to evaluate the association between obesity and composite poor outcome in coronavirus disease 2019 (COVID-19) patients. Methods: We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of mortality, morbidity, admission of Intensive Care Unit (ICU), mechanical ventilation, Acute Respiratory Distress Syndrome (ARDS), and severe COVID-19. Results: Nine studies were included in meta-analysis with 6 studies presented BMI as continuous outcome and 3 studies presented BMI as dichotomous outcome (obese and non-obese). Most studies were conducted in China (55.5%) with remaining studies from French, Germany, and United States (US). COVID-19 patients with composite poor outcome had higher BMI with mean difference 0.55 kg/m2 (95% CI 0.07-1.03, P=0.02). BMI ≥30 (obese) was associated with composite poor outcome with odds ratio 1.89 (95% CI 1.06-3.34, P=0.03). Multivariate meta-regression analysis by including three moderators: age, hypertension, and Diabetes Mellitus type 2 (DM type 2) showed the association between obesity and composite poor outcome was affected by age with regression coefficient =-0.06 and P=0.02. Subgroup analysis was not performed due to the limited number of studies for several outcomes. Conclusion: Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity. Keywords: Covid-19, Obesity, Body Mass Index