key: cord-0986844-df5t66yq
authors: Wang, Ying; Hou, Hongjie; Xu, Jie; Wang, Yadong; Yang, Haiyan
title: The association between obesity and ICU admission among COVID-19 patients: A meta-analysis of adjusted risk estimates
date: 2021-08-25
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2021.08.054
sha: 9a170488cf4038529a98f8130c18d4ec6f29e060
doc_id: 986844
cord_uid: df5t66yq

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primarily un-adjusted effect estimates, which means that the confounding factors were not considered. It was worth noting that obesity was significantly associated with an increased risk for ICU admission among COVID-19 patients based on age-adjusted analysis (effect size = 1.45, 95% confidence interval (CI): 1.23-1.70), but not while based on multivariable analysis (effect size = 1.15, 95% confidence interval (CI): 0.96-1.36) [1] , which suggests that the association between obesity and ICU admission among COVID-19 patients might be confounded by certain confounding factors. Up to now, a considerable number of studies reporting the association between obesity and ICU admission among COVID-19 patients using multivariable analysis adjusting for confounding factors with inconsistent findings have been published. Therefore, we performed a quantitative meta-analysis to estimate the risk factors-adjusted association between obesity and ICU admission among COVID-19 patients on the basis of adjusted effect estimates reported by all eligibly included studies.

This meta-analysis strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [2, 3] . We systematically searched PubMed, EMBASE and Web of Science databases to identify relevant literature which was published between January 1, 2020 and July 15, 2021. The keywords were used as follows: "coronavirus disease 2019" or "COVID-19" or "severe acute respiratory syndrome coronavirus 2" or "SARS-CoV-2" or "2019 novel coronavirus" or "2019-nCoV" and "obese" or "obesity" or "body mass index" or "BMI" and "intensive care unit admission" or "ICU admission". The exposure group was defined J o u r n a l P r e -p r o o f Journal Pre-proof as COVID-19 patients with obesity and the control group was defined as COVID-19 patients without obesity. The outcome of interest was ICU admission. All peer-reviewed articles published in English language regarding the association between obesity and ICU admission among COVID-19 patients using multivariable analysis were included. Duplications, case reports, corrections, reviews, preprints and studies reporting un-adjusted effect size were excluded. R software (Version 3.6.3) and Stata software (Version 11.2) were used for all statistical analyses. A random-effects meta-analysis model was applied to synthesize the pooled effect size and 95% CI [4, 5]. Higgins I 2 test was fitted to assess the inter-study heterogeneity [6] . Sensitivity analysis by omitting each study one time was performed to evaluate the robustness of our results [7] . Publication bias was assessed by Begg's rank correlation test [8] . Statistical significance was considered as P ≤ 0.05. Table 1 . Our meta-analysis based on adjusted effect estimates revealed that obesity was significantly associated with an increased risk for ICU admission among COVID-19 patients (pooled effect size = 1.84, 95% CI: 1.61-2.10, Figure 1A ). Consistent results were observed in the subgroup analyses by sample size Figure 1B ). Publication bias was not detected by Begg's test (P = 0.421).

In conclusion, this current meta-analysis based on adjusted effect estimates indicated that COVID-19 patients with obesity were at high risk for ICU admission.

Further well-designed studies with large sample sizes are warranted to verify our findings. Leave-one-out sensitivity analysis showed that our results were robust and stable. * indicates combined effects based on subgroups.

J o u r n a l P r e -p r o o f

BMI and Outcomes of SARS-CoV-2 Among US Veterans

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis'. Annals of the rheumatic diseases

Measuring inconsistency in meta-analyses

An updated meta-analysis on the association between tuberculosis and COVID-19 severity and mortality

Operating characteristics of a rank correlation test for publication bias

We would like to thank Peihua Zhang, Yang Li, Jian Wu, Wenwei Xiao, Xuan Liang and Li Shi (All are from Department of Epidemiology,