COVID-19 and the role of chronic inflammation in patients with obesity

Int J Obes (Lond). 2020 Aug;44(8):1790-1792. doi: 10.1038/s41366-020-0597-4. Epub 2020 May 14.

Abstract

Coronavirus disease 2019 (COVID-19) and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a particular risk to people living with preexisting conditions that impair immune response or amplify pro-inflammatory response. Low-grade chronic systemic inflammation, common in people with obesity, is associated with the development of atherosclerosis, type 2 diabetes, and hypertension, well known comorbidities that adversely affect the outcomes of patients with COVID-19. Risk stratification based on the Edmonton Obesity Staging System (EOSS), which classifies obesity based on the presence of medical, mental, and/or functional complications rather than on body mass index (BMI), has been shown to be a better predictor of all-cause mortality and it may well be that EOSS stages may better describe the risk of hyperinflammation in patients with COVID-19 infection. Analyzing a group of metabolic ill patients with obesity (EOSS 2 and 3), we found an increased interleukin-6 and linear regression analysis showed a positive correlation with C-reactive protein (CRP) (p = 0.014) and waist-to-hip-ratio (WHR) (p = 0.031). Physicians should be aware of these findings in patients with COVID-19 infection. Early identification of possible hyperinflammation could be fundamental and should guide decision making regarding hospitalization, early respiratory support, and therapy with immunosuppression to improve mortality.

MeSH terms

  • Adult
  • Betacoronavirus / pathogenicity
  • Body Mass Index
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / physiopathology
  • Coronavirus Infections / therapy
  • Cytokine Release Syndrome / physiopathology
  • Cytokine Release Syndrome / virology*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / immunology
  • Diabetes Mellitus, Type 2 / physiopathology
  • Early Diagnosis
  • Female
  • Health Care Surveys
  • Humans
  • Immunosuppression Therapy / statistics & numerical data
  • Inflammation / physiopathology
  • Inflammation / virology*
  • Linear Models
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / immunology
  • Obesity / physiopathology
  • Pandemics
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / physiopathology
  • Pneumonia, Viral / therapy
  • Respiration, Artificial / statistics & numerical data*
  • Risk Assessment
  • SARS-CoV-2
  • Severity of Illness Index