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Hossam Abd El-Moez Mohammed,1 Mohammed H Hassan,2 Hytham Abdalla,3 Marwa Ahmed Mahmoud,4 Amira Maher,5 Mohamed Malak,6 Mohammed Tag-Adeen,7 Mohamed Ramadan Izzaldin,8 Sara Adel,8 Wael Esmat Ali,8 Alyaa Abo-Rahma,9 Mona Gouda Maghrabi Abd Elnabi,10 Ibrahim Ahmed Mosa Abdalla,11 Mohamed Fakhry Mohamed Morsy,12 Mohamed Abdel Fattah Mohamed Sayed,13 Usama Mohamed Abdelaal6 1Department of Chest Diseases, Faculty of Medicine, Luxor University, Luxor, Egypt; 2Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 3Department of Chest Diseases, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 4Department of Medical Physiology, Faculty of Medicine, Sohag University, Sohag, Egypt; 5Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Sohag, Egypt; 6Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt; 7Department of Internal Medicine, Division of Gastroenterology and Hepatology, Faculty of Medicine, South Valley University, Qena, 83523, Egypt; 8Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 9Department of Public Health and Community Medicine, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 10Department of Diagnostic Radiology, Faculty of Medicine, Luxor University, Luxor, Egypt; 11Anasthesia and Critical Care Department, Faculty of Medicine, Luxor University, Luxor, Egypt; 12Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt; 13Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan, EgyptCorrespondence: Mohammed H Hassan, Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt, Tel +20 1009097968, Email mohammedhosnyhassaan@yahoo.com; mohammedhosnyhassaan@med.svu.edu.egBackground: Extreme body mass index (BMI) is an influential pathophysiological risk factor for serious illnesses following lower respiratory tract infection. The purpose of the current study was to examine how the BMI of Coronavirus disease-19 (COVID-19) patients affects their prognosis.Methods: Two hundred patients with COVID-19 admitted to Al-Azhar, Qena, Aswan, and Sohag University hospitals in Egypt were included and categorized into four groups according to their BMI. The diagnosis was made according to a real-time reverse transcription-polymerase chain reaction (rRT-PCR) positive result for the SARS-CoV-2 nucleic acid in swabs from upper respiratory tract. A detailed history, clinical examination, and outcomes (disease severity and complications, hospital stay, ICU admission, mortality) were recorded for all patients. SPSS version 24 software was used for data analysis.Results: Average age of participants (19– 90 years old), 92 (46%) males and 108 females (54%). ICU admission was significantly higher among underweight patients (75%) and obese patients (78.6%). The majority of underweight (62.5%) and obese (57.1%) patients had critical disease. Invasive mechanical ventilation (MV) is frequently used in underweight (50%) and obese patients (42.9%) patients. Adult respiratory distress syndrome (ARDS), cardiac, neurological, and hematological complications, and incidence of myalgia and bed sores were most frequent among obese and overweight patients. Acute kidney injury was significantly higher among underweight patients (37.5%) and obese patients (28.6%) than among other classes (p=0.004). Frequency of endocrine complications was significantly higher in underweight patients than that in other classes (p=0.01). The majority of underweight (75%) and obese patients (50%) deteriorated and died, whereas the majority of normal-weight patients (90.3%) and overweight patients (75.8%) improved and were discharged (p< 0.001).Conclusion: Body mass index is a major contributing factor to the outcome of patients with COVID-19, and patients with extreme of body mass index were associated with the worst prognosis.Keywords: body mass index, COVID-19, obese, underweight, intensive care unit