Objective: To estimate the association of obesity with severity (defined as use of invasive mechanical ventilation or intensive care unit admission) and all-cause mortality in coronavirus disease 2019 (COVID-19) patients. Patients and Methods: A systematic search was conducted from inception of COVID-19 pandemic through January 31st, 2021 for full-length articles focusing on the association of increased BMI/ Obesity and outcome in COVID-19 patients with help of various databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for study selection and data extraction. The severity in hospitalized COVID-19 patients, such as requirement of invasive mechanical ventilation and intensive care unit admission with high BMI/ Obesity was the chief outcome. While all-cause mortality in COVID-19 hospitalized patients with high BMI/ Obesity was the secondary outcome. Results: A total of 576,784 patients from 100 studies were included in this meta-analysis. Being obese was associated with increased risk of severe disease (RR=1.46, 95% CI 1.34-1.60, p<0.001, I2 = 92 %). Similarly, high mortality was observed in obese patients with COVID-19 disease (RR=1.12, 95% CI 1.06-1.19, p<0.001, I2 = 88%). In a multivariate meta-regression on severity outcome, the covariate of female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2= 50% of the between-study heterogeneity for severity. Similarly, for mortality outcome, covariate of female gender, proportion of pulmonary disease, diabetes, hypertension, and cardiovascular diseases were significant, these covariates collectively explained R2=53% of the between-study variability for mortality. Conclusions: Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and streamlining the management strategy and treatment guidelines to account for the impact of obesity in patient care management is recommended.

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肥胖与COVID-19严重度和死亡率的关联：系统评价和Meta回归

目的：评估肥胖与严重程度（定义为使用有创机械通气或重症监护病房）和2019年冠状病毒病（COVID-19）患者全因死亡率之间的关系。患者和方法：从COVID-19大流行开始到2021年1月31日，系统地搜索了全文，重点研究了COVID-19患者BMI /肥胖增加与结局的相关性，并借助包括Medline（ PubMed），Embase，Science Web和Cochrane中央对照试验注册中心。还扫描了预印服务器，例如BioRxiv，MedRxiv，ChemRxiv和SSRN。系统评价和荟萃分析（PRISMA）指南的首选报告项目用于研究选择和数据提取。在住院的COVID-19患者中的严重程度，主要结果是，例如需要有创机械通气和重症监护病房/肥胖症重症监护病房。次要的结果是，BMI /肥胖高的住院患者的COVID-19的全因死亡率。结果：这项荟萃分析纳入了来自100项研究的576,784名患者。肥胖与严重疾病的风险增加相关（RR = 1.46，95％CI 1.34-1.60，p <0.001，I2 = 92％）。同样，在患有COVID-19疾病的肥胖患者中观察到高死亡率（RR = 1.12，95％CI 1.06-1.19，p <0.001，I2 = 88％）。在严重程度结果的多元荟萃回归中，女性，肺部疾病，糖尿病，老年，心血管疾病和高血压的协变量被认为是显着的，并解释了R2 =严重程度研究间异质性的50％。同样，对于死亡率结果，女性性别，肺部疾病，糖尿病，高血压和心血管疾病比例的协变量也很显着，这些协变量共同解释了R2 =研究间死亡率变异性的53％。结论：我们的发现表明，肥胖与COVID-19患者的病情严重程度增加和死亡率升高显着相关。因此，建议在预后评分中纳入肥胖或其替代体重指数，并简化管理策略和治疗指南，以考虑肥胖对患者护理管理的影响。这些协变量共同解释了R2 =死亡率之间研究间变异性的53％。结论：我们的发现表明，肥胖与COVID-19患者的病情严重程度增加和死亡率升高显着相关。因此，建议在预后评分中纳入肥胖或其替代体重指数，并简化管理策略和治疗指南，以考虑肥胖对患者护理管理的影响。这些协变量共同解释了R2 =死亡率之间研究间变异性的53％。结论：我们的发现表明，肥胖与COVID-19患者的病情严重程度增加和死亡率升高显着相关。因此，建议在预后评分中纳入肥胖或其替代体重指数，并简化管理策略和治疗指南，以考虑肥胖对患者护理管理的影响。