The Effect of Body Mass Index on Presentation of COVID-19 amongst Heart Transplant Recipients: A Multi-Institutional Study

Purpose

Characteristics and outcomes of heart transplant (HT) recipients who contract coronavirus (SARS-CoV-2) have been poorly described. The current study was undertaken to better understand the risk obesity may pose in this patient population

Methods

A prospectively-maintained Trans-CoV-VAD Registry containing HT recipients at 11 participating institutions who presented with SARS-CoV-2 were reviewed. Presenting characteristics, hospitalization rates, ventilator & intensive care unit usage, and mortality were queried. Patients were grouped by body mass index (BMI) into obese (BMI≥30 k/m²) and non-obese cohorts (BMI<30 kg/m²). Comparisons between groups were made utilizing chi-squared, Fisher's exact, and Mann-Whitney U-tests. Multivariable logistic regression models were utilized

Results

Across all centers, 85 HT recipients who tested positive for SARS-CoV-2 were identified, of whom 26 (31%) were obese. Median time from HT to diagnosis was 4.6 (1.8-13.8) years. No differences in age (57 vs 60 p 0.85) or female gender (31% vs 24% p 0.5) were noted between obese and non-obese patients. On presentation, obese patients were more symptomatic with higher rates of cough (76% vs 48% p 0.02), dyspnea (62% vs 41% p 0.09), diarrhea (60% vs 35% p 0.03), and headache (35% vs 14% p 0.03). No differences in rates of admission (62% vs 64% p 0.8), ICU presentation (44% vs 35% p 0.6) or need for mechanical ventilation were noted (38% vs 22% p 0.2). More secondary infections were noted amongst obese patients (32% vs 13% p 0.04). On follow-up, mortality was similar between groups (12% vs 9% p 0.7). On multivariable modeling, BMI was not associated with increased adjusted odds of hospital/ICU admission or mechanical ventilation (p>0.10)

Conclusion

Acute presentations of SARS-CoV-2 amongst HT recipients carry significantly higher mortality over the general population. Obesity appears to impact presenting symptoms and secondary infections, but does not strongly impact ICU requirements or mortality