BMI and mortality in critically ill patients with COVID-19: another brick in the wall of the obesity paradox.

Objective: The objective of this study was to assess the existence of the obesity paradox in patients with COVID-19 admitted to the intensive care unit.
Methods: This was a multicentric retrospective cohort study including individuals aged 18 years or older admitted to the intensive care unit with SARS-CoV-2. Data were obtained from electronic medical records. The primary outcome was in-hospital mortality. Multiple logistic regression and restricted cubic splines analyses were conducted to assess the association between BMI and mortality.
Results: From March 2020 to December 2021, 977 patients met the inclusion criteria, and 868 were included in the analysis. Obesity was identified in 382 patients (44%). Patients with obesity more often underwent prone positioning (42% vs. 28%; p < 0.001), although they used less vasoactive medications (57% vs. 68%; p < 0.001). The overall in-hospital mortality was 48%, with 44% observed in the subgroup of individuals with obesity and 50% in those without obesity (p = 0.06). Patients with BMI < 25 kg/m ² had the highest mortality.
Conclusions: Obesity was not associated with higher mortality rates in critically ill patients with COVID-19. Moreover, patients with BMI < 25 kg/m ² had a higher mortality rate compared with those in higher BMI categories.
(© 2024 The Obesity Society.)