Objectives

Initial studies of individuals with coronavirus disease 2019 (COVID-19) revealed that obesity, diabetes and hypertension were associated with severe outcomes. Subsequently, some authors showed that the risk could vary according to age, gender, co-morbidities and medical history. In a nationwide retrospective cohort, we studied the association between these co-morbidities and patients' requirement for invasive mechanical ventilation (IMV) or their death.

Methods

All French adult inpatients with COVID-19 admitted during the first epidemic wave (February to September 2020) were included. When patients were diagnosed with obesity, diabetes or hypertension for the first time in 2020, these conditions were considered as incident co-morbidities, otherwise they were considered prevalent. We compared outcomes of IMV and in-hospital death according to obesity, diabetes and hypertension, taking age, gender and Charlson's co-morbidity index score (CCIS) into account.

Results

A total of 134 209 adult inpatients with COVID-19 were included, half of them had hypertension (n = 66 613, 49.6%), one in four were diabetic (n = 32 209, 24.0%), and one in four were obese (n = 32 070, 23.9%). Among this cohort, IMV was required for 13 596 inpatients, and 19 969 patients died. IMV and death were more frequent in male patients (adjusted oods ratio (aOR) 2.0, 95% CI 1.9–2.1 and aOR 1.5, 95% CI 1.4–1.5, respectively), IMV in patients with co-morbidities (aOR 2.1, 95% CI 2.0–2.2 for CCIS = 2 and aOR 3.0, 95% CI 2.8–3.1 for CCIS ≥5), and death in patients aged 80 or above (aOR 17.0, 95% CI 15.5–18.6). Adjusted on age, gender and CCIS, death was more frequent among inpatients with obesity (aOR 1.2, 95% CI 1.1–1.2) and diabetes (aOR 1.2, 95% CI 1.1–1.2). IMV was more frequently necessary for inpatients with obesity (aOR 1.9, 95% CI 1.8–2.0), diabetes (aOR 1.4, 95% CI 1.3–1.4) and hypertension (aOR 1.7, 95% CI 1.6–1.8). Comparatively, IMV was more often required for patients with the following incident co-morbidities: obesity (aOR 3.5, 95% CI 3.3–3.7), diabetes (aOR 2.0, 95% CI 1.8–2.1) and hypertension (aOR 2.5, 95% CI 2.4–2.6).

Conclusions

Among 134 209 inpatients with COVID-19, mortality was more frequent among patients with obesity and diabetes. IMV was more frequently necessary for inpatients with obesity, diabetes and hypertension. Patients for whom these were incident co-morbidities were particularly at risk. Specific medical monitoring and vaccination should be priorities for patients with these co-morbidities.

中文翻译：

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2019 年冠状病毒病住院患者的肥胖、糖尿病、高血压和严重后果：一项全国性研究

目标

对 2019 年冠状病毒病 (COVID-19) 患者的初步研究表明，肥胖、糖尿病和高血压与严重后果有关。随后，一些作者表明，风险可能因年龄、性别、合并症和病史而异。在一个全国性的回顾性队列中，我们研究了这些合并症与患者对有创机械通气 (IMV) 的需求或他们的死亡之间的关联。

方法

包括在第一波流行波（2020 年 2 月至 9 月）期间入院的所有法国成年 COVID-19 住院患者。当患者在 2020 年首次被诊断出患有肥胖症、糖尿病或高血压时，这些情况被视为合并症，否则被视为普遍存在。我们根据肥胖、糖尿病和高血压，比较了 IMV 和院内死亡的结果，同时考虑了年龄、性别和 Charlson 的合并症指数评分 (CCIS)。

结果

共纳入 134 209 名成年 COVID-19 住院患者，其中一半患有高血压（n =  66 613，49.6 %），四分之一患有糖尿病（n =  32 209，24.0%），四分之一患有肥胖症( n = 32 070, 23.9%)。在该队列中，13 596 名住院患者需要 IMV，19 969 名患者死亡。IMV 和死亡在男性患者中更常见（调整后的 oods 比 (aOR) 2.0，95% CI 1.9-2.1 和 aOR 1.5，95% CI 1.4-1.5），IMV 在有合并症的患者中（aOR 2.1, 95 CCIS = 2 的 % CI 2.0–2.2 和 aOR 3.0，CCIS ≥5 的 95% CI 2.8–3.1）和 80 岁或以上患者的死亡（aOR 17.0，95% CI 15.5–18.6）。调整年龄、性别和 CCIS 后，肥胖（aOR 1.2，95% CI 1.1-1.2）和糖尿病（aOR 1.2，95% CI 1.1-1.2）住院患者的死亡率更高。对于患有肥胖症 (aOR 1.9, 95% CI 1.8–2.0)、糖尿病 (aOR 1.4, 95% CI 1.3–1.4) 和高血压 (aOR 1.7, 95% CI 1.6–1.8) 的住院患者，IMV 更常见。相比之下，有以下并发症的患者更常需要 IMV：

结论

在 134 209 名 COVID-19 住院患者中，肥胖和糖尿病患者的死亡率更高。肥胖、糖尿病和高血压住院患者更常需要 IMV。对于这些是事件合并症的患者而言，风险尤其高。有这些合并症的患者应优先考虑特定的医学监测和疫苗接种。