COVID-19 sévère, une nouvelle complication à ajouter aux nombreuses comorbidités de l’obésité.

Betacoronavirus; Coronavirus Infections; Humans; Obesity/complications/epidemiology; Pandemics; Pneumonia, Viral; Intensive care; Mechanical ventilation; Mortality; Prognosis; SARS; 2; ARDS; Cov

Abstract :

[en] Obesity is associated with a huge number of well-known comorbidities. Nowadays, it represents a higher risk of severe COVID-19 infection, which may lead to the requirement of a mechanical ventilation in intensive care units and premature death. The increase in relative risk of poor prognosis in presence of obesity is particularly high in patients at a younger age. The underlying mechanisms are multiple: alteration of the respiratory performance, presence of frequent comorbidities (diabetes, hypertension or obstructive sleep apnea), finally inadequate and excessive immunological responses, with massive liberation of cytokines (especially interkeukin-1 and interleukin-6). Thus, COVID-19 may challenge the so-called «obesity paradox» in intensive care units among patients with acute respiratory distress syndrome where obesity is commonly reported as associated with a better prognosis. In the special case of COVID-19, a condition where obviously obesity aggravates the prognosis, hypothetical mechanisms remain to be well-defined and deserve further validation.
[fr] L’obésité est associée à une panoplie de complications diverses, bien connues. Elle représente, maintenant aussi, un risque augmenté d’infection COVID-19 sévère, conduisant à des hospitalisations plus fréquentes, un besoin accru d’assistance respiratoire en unités de soins intensifs (USI) et, in fine, une surmortalité. L’augmentation relative du risque par rapport aux personnes non obèses concerne surtout les sujets jeunes. Les raisons d’un moins bon pronostic sont multiples : altération de la mécanique ventilatoire, présence fréquente de comorbidités (diabète, hypertension ou apnée obstructive du sommeil,) enfin, des réactions immunologiques et inflammatoires inappropriées et excessives, avec libération de cytokines (interleukine-1 and interleukine-6, notamment). Ainsi, la COVID-19 semble remettre en cause l’«obesity paradox», décrit dans les USI chez les patients avec un syndrome de détresse respiratoire aiguë où l’obésité était, habituellement, considérée comme conférant une issue plus favorable. Dans le cas particulier, la spécificité de la COVID-19, condition où l’obésité aggrave nettement le pronostic, fait l’objet d’hypothèses mécanistiques qui doivent encore être validées.

Disciplines :

Immunology & infectious disease

Author, co-author :

DE FLINES, Jenny ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de diabétologie, nutrition, maladies métaboliques

Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques

Language :

French

Title :

COVID-19 sévère, une nouvelle complication à ajouter aux nombreuses comorbidités de l’obésité.

Alternative titles :

[en] Severe COVID-19, a new complication to be added to numerous comorbidities associated to obesity

Publication date :

2020

Journal title :

Revue Médicale de Liège

ISSN :

0370-629X

eISSN :

2566-1566

Publisher :

Université de Liège. Revue Médicale de Liège, Liège, Belgium

Special issue title :

COVID-19

Volume :

Issue :

Pages :

146-152

Available on ORBi :

since 03 December 2020

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