Obesity, ethnicity and risk of critical care, mechanical ventilation and mortality in patients admitted to hospital with COVID-19: Analysis of the ISARIC CCP-UK cohort.

Objective: The  aim  of  this  study  was  to  investigate  the  asso-ciation  of  obesity  with  in-  hospital  coronavirus  disease  2019  (COVID- 19) outcomes in different ethnic groups.Methods: Patients  admitted  to  hospital  with  COVID-  19  in  the  United  Kingdom  through  the  Clinical  Characterisation  Protocol  UK  (CCP-  UK)  developed  by  the  International  Severe  Acute  Respiratory and emerging Infections Consortium (ISARIC) were included  from  February  6  to  October  12,  2020.  Ethnicity  was  classified as White, South Asian, Black, and other minority eth-nic groups. Outcomes were admission to critical care, mechani-cal  ventilation,  and  in-  hospital  mortality,  adjusted  for  age,  sex,  and chronic diseases.Results: Of  the  participants  included,  54,254  (age  =  76  years;  45.0%  women)  were  White,  3,728  (57  years;  41.1%  women)  were South Asian, 2,523 (58 years; 44.9% women) were Black, and  5,427  (61  years;  40.8%  women)  were  other  ethnicities.  Obesity was associated with all outcomes in all ethnic groups, with associations strongest for black ethnicities. When stratified by ethnicity and obesity status, the odds ratios for admission to critical care, mechanical ventilation, and mortality in black eth-nicities with obesity were 3.91 (3.13- 4.88), 5.03 (3.94- 6.63), and 1.93  (1.49-  2.51),  respectively,  compared  with  White  ethnicities  without obesity.Conclusions: Obesity  was  associated  with  an  elevated  risk  of  in- hospital COVID- 19 outcomes in all ethnic groups, with asso-ciations strongest in Black ethnicities.</p

Outcomes of hospitalised immunocompromised patients, compared with immunocompetent patients.

Odds ratios (ORs) from multivariable logistic regression and 95% confidence intervals (CIs) for outcomes of death, critical care admission, noninvasive and invasive ventilation, adjusted for age, sex, ethnicity, socioeconomic deprivation, chronic cardiac, pulmonary and renal disease, and vaccination status.</p

Outcomes by reason for immunocompromise.

Data are numbers of patients (%).</p

Outcomes of hospitalised immunocompromised patients, compared with immunocompetent patients over the first 4 pandemic waves in the UK.

Odds ratios (ORs) from multivariable logistic regression and 95% confidence intervals (CIs) for outcomes of death, broken down by pandemic wave, adjusted for age, sex, ethnicity, socioeconomic deprivation, comorbidity count (not including the immunocompromising condition), and vaccination status. Wave 1 was 17 January to 31 August 2020; wave 2 was 1 September 2020 to 31 March 2021; wave 3 was 1 April 2021 to 12 December 2021; and wave 4 was 13 December 2021 to 28 February 2022.</p

Flow diagram of patients in the study.

The total number of participants entered into the ISARIC CCP-UK database, reasons for exclusion, and numbers of patients in each category of immunocompromise are shown. CCP-UK, Clinical Characterisation Protocol in the United Kingdom; COVID-19, Coronavirus Disease 2019; ISARIC, International Severe Acute Respiratory and emerging Infection Consortium.</p

Number of admissions of immunocompetent and immunocompromised patients over time.

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STROBE Checklist.

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Outcomes by reason for immunocompromise.

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Number (%) of patients receiving steroids and tocilizumab by immune status and pandemic wave.

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Steroid usage by immune status in the first 4 pandemic waves in the UK.

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