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Obesidad: un factor de riesgo en pacientes con COVID-19
Resumen
Informes recientes dan cuenta de una fuerte asociación entre la obesidad y la severidad de la infección de COVID-19, lo cual se fundamenta en la presencia de un estado proinflamatorio crónico en el paciente obeso, vinculado a trastornos metabólicos y del sistema inmune. Este trabajo tiene como objetivo revisar los más recientes estudios sobre la asociación positiva que se establece entre la obesidad, como factor de riesgo, y la severidad y mortalidad de los pacientes con COVID-19; también renovar los mecanismos involucrados, para lo cual se seleccionaron artículos publicados —principalmente en los últimos cinco años— en las bases de datos PubMed, SciELO, ClinicalKey y LILACS, y en el motor de búsqueda Google Académico. Estos estudios incluyeron, entre otros parámetros, el índice de masa corporal y su asociación a la severidad y mortalidad por COVID-19. Como resultado, la evidencia clínica sugiere que el sobrepeso y la obesidad presentan una alta prevalencia en los casos severos de pacientes adultos con COVID-19. Se concluye que la obesidad, en estos pacientes, requiere de un manejo particular, pues debe ser considerada un factor de riesgo independiente de otras comorbilidades. Esto se debe a su contribución a una mayor susceptibilidad y severidad, asociándose positivamente con alteraciones del sistema inmune y con reacciones hiperinflamatorias por liberación excesiva de citoquinas, comprometiendo el funcionamiento de órganos y sistemas y potenciando las complicaciones de la infección de SARS-CoV-2 y la mortalidad.
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Referencias
World Health Organization. Obesity and overweight [Internet]. Geneva: WHO; 2020 [citado 05/03/2021]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med [Internet]. 2019 [citado 05/03/2021];381:2440-50. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMsa1909301
Ulhaq ZS, Soraya GV. Interleukin‐6 as a potential biomarker of COVID‐19 progression. Med mal Infect. 2020;50(4):382-3. Citado en PubMed; PMID: 32259560.
Fischer-Posovszky P, Moller P. The immune system of adipose tissue: obesity-associated inflammation. Der Pathologe [Internet]. 2020 [citado 05/03/2021];41(3):224-9. Disponible en: https://europepmc.org/article/med/32253498
Dennis JM, McGovern AP, Vollmer SJ, et al. Improving Survival of Critical Care Patients with Coronavirus Disease 2019 in England: A National Cohort Study, March to June 2020. Crit Care Med [Internet]. 2021 [citado 15/04/2021];49(2):209-14. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803441/
Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City [Internet]. New York: medRxiv; 2020 [citado 05/03/2021]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1
Moser JS, Galindo-Fraga A, Ortiz-Hernández AA, et al. Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses. Influenza Other Respir Viruses [Internet]. 2019 [citado 12/03/2021];13(1):3-9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/irv.12618
Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol [Internet]. 2020 [citado 12/03/2021];251(3):228-48. Disponible en: https://pathsocjournals.onlinelibrary.wiley.com/doi/full/10.1002/path.5471
Aksoy H, Karadag AS, Wollina U. Angiotensin II receptors: Impact for COVID-19 severity. Dermatol Ther [Internet]. 2020 [citado 12/03/2021];33(6):e13989. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.13989
Naveed M, Naeem M, Ur Rahman M, et al. Review of potential risk groups for coronavirus disease 2019 (COVID-19). New Microbes New Infect [Internet]. 2021 [citado 27/07/2021];41:100849. Disponible en: https://www.sciencedirect.com/science/article/pii/S2052297521000135
Goumenou M, Sarigiannis D, Tsatsakis A, et al. COVID 19 in Northern Italy: An integrative overview of factors possibly influencing the sharp increase of the outbreak. Mol Med Rep [Internet]. 2020 [citado 12/03/2021];22(1):20-32. Disponible en: https://www.spandidos-publications.com/10.3892/mmr.2020.11079?text=fulltext
Reddy P, Lent-Schochet D, Ramakrishnan N, et al. Metabolic syndrome is an inflammatory disorder: a conspiracy between adipose tissue and phagocytes. Clin Chim Acta [Internet]. 2019 [citado 12/03/2021];496:35-44. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S000989811931928X
Landecho MF, Marin-Oto M, Recalde-Zamacona B, et al. Obesity as an adipose tissue dysfunction disease and a risk factor for infections - Covid-19 as a case study. Eur J Intern Med [Internet]. 2021 [citado 12/03/2021];91:3-9. Disponible en: https://www.sciencedirect.com/science/article/pii/S0953620521000972
Ryan PM, Caplice NM. Is adipose tissue a reservoir for viral spread, immune activation, and cytokine amplification in coronavirus disease 2019? Obesity [Internet]. 2020 [citado 15/03/2021];28(7):1191-4. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.22843
Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet [Internet]. 2020 [citado 15/03/2021];395(10229):1033-4. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
Hussain A, Mahawar K, Xia Z, et al. RETRACTED: Obesity and mortality of COVID-19. Meta-analysis. Obes Res Clin Pract [Internet]. 2020 [citado 15/03/2021];14(4):295-300. Disponible en: https://www.sciencedirect.com/science/article/pii/S1871403X20305500
Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clinical Infect Dis [Internet]. 2020 [citado 15/03/2021];71(15):896-7. Disponible en: https://academic.oup.com/cid/article/71/15/896/5818333?login=false
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA [Internet]. 2020 [citado 22/03/2021];323(20):2052-9. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2765184/
Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity [Internet]. 2020 [citado 22/03/2021];28(7):1195-9. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22831
Barrasa H, Rello J, Tejada S, et al. SARS-Cov-2 in Spanish intensive care: early experience with 15-day survival in Vitoria. Anaesth Crit Care Pain Med [Internet]. 2020 [citado 22/03/2021];39(5):553-61. Disponible en: https://www.sciencedirect.com/science/article/pii/S2352556820300643
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA [Internet]. 2020 [citado 22/03/2021];323(18):1775-6. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/2763667
Huang JF, Wang XB, Zheng KI, et al. Obesity hypoventilation syndrome and severe COVID-19. Metabolism [Internet]. 2020 [citado 22/03/2021];108. Disponible en: https://www.metabolismjournal.com/article/S0026-0495(20)30113-X/fulltext
Pandey A, Patel KV, Lavie CJ. Obesity, central adiposity, and fitness: understanding the obesity paradox in the context of other cardiometabolic parameters. Mayo Clin Proc [Internet]. 2018 [citado 22/03/2021];93(6):676-8. Disponible en: https://www.mayoclinicproceedings.org/article/S0025-6196(18)30314-8/fulltext
Sanchis-Gomar F, Perez-Quilis C, Lavie CJ. Should atrial fibrillation be considered a cardiovascular risk factor for a worse prognosis in COVID-19 patients? Eur Heart J [Internet]. 2020 [citado 22/03/2021];41(32):3092-3. Disponible en: https://academic.oup.com/eurheartj/article/41/32/3092/5874071?login=false
Kwaifa IK, Bahari H, Yong YK, et al. Endothelial dysfunction in obesity-induced inflammation: molecular mechanisms and clinical implications. Biomolecules [Internet]. 2020 [citado 04/04/2021];10(2). Disponible en: https://www.mdpi.com/2218-273X/10/2/291
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endothelitis in COVID-19. The Lancet [Internet]. 2020 [citado 04/04/2021];395(10234):1417-8. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30937-5/fulltext?a=true
Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med [Internet]. 2020 [citado 04/04/2021];173(4):268-77. Disponible en: https://www.acpjournals.org/doi/full/10.7326/M20-2003
Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost [Internet]. 2020 [citado 04/04/2021];18(4):844-7. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14768
Malavazos AE, Goldberger JJ, Iacobellis G. Does epicardial fat contribute to COVID-19 myocardial inflammation? Eur Heart J [Internet]. 2020 [citado 04/04/2021];41(24):2333. Disponible en: https://academic.oup.com/eurheartj/article/41/24/2333/5848374?login=false
Neeland IJ, Ross R, Despres JP, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol [Internet]. 2019 [citado 04/04/2021];7(9):715-25. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30084-1/fulltext
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