Effects of bariatric surgery on the prognosis of obese COVID-19 patients： a meta analysis

doi:10.3969/j.issn.1009-976X.2023.06.003

Abstract

Abstract: Objective To investigate whether bariatric surgery has a protective effect against COVID-19 infection in obese patients. Methods A computer search of medical literature databases, including PubMed, Cochrane Library, Embase, CNKI, Wanfang, etc., was conducted to search for relevant studies on the prognotic effects of previous bariatric surgery on OBESE patients infected with COVID-19. The search period was from January 2020 to June 2023. Results A total of 9 retrospective studies were included. Meta-analysis showed that bariatric surgery could reduce mortality after COVID-19 infection in obese patients （OR=0.46, 95%CI： 0.41-0.51,P<0.00001）. The hospitalization rate decreased （OR=0.67, 95%CI： 0.48-0.93,P=0.02）; Mechanical ventilation rate decreased （OR=0.47, 95%CI： 0.44-0.51,P<0.00001）; ICU admission rate decreased （OR=0.49, 95%CI： 0.35-0.67,P<0.00001）. Conclusion Previous bariatric surgery significantly improves the adverse outcomes of COVID-19 in obese patients

Key words: bariatric surgery, COVID-19, obesity, meta-analysis

摘要： 目的探讨减重手术对肥胖患者感染新冠肺炎是否具有保护作用。方法计算机检索医学文献数据库,包括PubMed、Cochrane Library、Embase、中国知网、万方等检索既往行减重手术对肥胖患者感染新冠肺炎的预后影响的相关研究。结果共纳入9项回顾性研究。Meta分析结果示：减重手术可使肥胖患者新冠肺炎感染后的死亡率下降（OR=0.46,95%CI：0.41~0.51,P<0.00001）;住院率下降（OR=0.67,95%CI：0.48~0.93,P=0.02）;机械通气率下降（OR=0.47,95%CI：0.44~0.51,P<0.00001）;ICU入住率下降（OR=0.49,95%CI：0.35~0.67,P<0.00001）。结论既往行减重手术可以明显改善肥胖患者新冠肺炎的不良结局。

关键词: 减重手术, 新型冠状病毒肺炎, 肥胖, Meta 分析

CLC Number:

R656.6

YU He, HUANG Liang-liang. Effects of bariatric surgery on the prognosis of obese COVID-19 patients： a meta analysis[J]. Lingnan Modern Clinics In Surgery, 2023, 23(6): 460-467.

于鹤, 黄亮亮. 减重手术对肥胖新冠肺炎患者预后影响的Meta分析[J]. 岭南现代临床外科, 2023, 23(6): 460-467.

References

[1] Muller LM, Gorter KJ, Hak E, et al.Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus[J]. Clin Infect Dis, 2005, 41(3): 281-288.
[2] Luzi L, Radaelli MG.Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic[J]. Acta Diabetol, 2020, 57(6): 759-764.
[3] Lighter J, Phillips M, Hochman S, et al.Obesity in Patients Younger Than 60 Years Is a Risk Factor for COVID-19 Hospital Admission[J]. Clin Infect Dis, 2020, 71(15): 896-897.
[4] Bhutani S, Cooper JA.COVID-19-Related Home Confinement in Adults: Weight Gain Risks and Opportunities[J]. Obesity (Silver Spring), 2020, 28(9): 1576-1577.
[5] Maciejewski ML, Arterburn DE, Van Scoyoc L, et al.Bariatric Surgery and Long-term Durability of Weight Loss[J]. JAMA Surg, 2016, 151(11): 1046-1055.
[6] Schauer PR, Bhatt D L, Kirwan JP, et al.Bariatric Surgery versus Intensive Medical Therapy for Diabetes-5-Year Outcomes[J]. N Engl J Med, 2017, 376(7): 641-651.
[7] Aminian A, Fathalizadeh A, Tu C, et al.Association of prior metabolic and bariatric surgery with severity of coronavirus disease 2019 (COVID-19) in patients with obesity[J]. Surg Obes Relat Dis, 2021, 17(1): 208-214.
[8] Uccelli M, Cesana GC, Ciccarese F, et al.“COVID-19 and Obesity: Postoperative Risk in Patients Who Have Undergone Bariatric Surgery. Preliminary Report from High Volume Center in Italy (Lombardy)”[J]. Obes Surg, 2020, 30(12): 5119-5122.
[9] Purdy AC, Hohmann SF, Nguyen NT.Outcomes of obese patients hospitalized with COVID-19: the impact of prior bariatric surgery[J]. Surg Obes Relat Dis, 2022, 18(1): 35-40.
[10] Iannelli A, Bouam S, Schneck AS, et al.The Impact of Previous History of Bariatric Surgery on Outcome of COVID-19. A Nationwide Medico-Administrative French Study[J]. Obes Surg, 2021, 31(4): 1455-1463.
[11] Blanchard C, Perennec T, Smati S, et al.History of bariatric surgery and COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study[J]. Obesity (Silver Spring), 2022, 30(3): 599-605.
[12] Marchesi F, Valente M, Ricco M, et al.Effects of Bariatric Surgery on COVID-19: a Multicentric Study from a High Incidence Area[J]. Obes Surg, 2021, 31(6): 2477-2488.
[13] Moradpour G, Amini M, Moeinvaziri N, et al.Bariatric Surgery and COVID-19: What We Have Learned from the Pandemic in Iran: a Retrospective Observational Cohort Study[J]. Obes Surg, 2022, 32(1): 18-25.
[14] Jenkins M, Maranga G, Wood GC, et al.Prior bariatric surgery in COVID-19-positive patients may be protective[J]. Surg Obes Relat Dis, 2021, 17(11): 1840-1845.
[15] Hadi YB, Mann R, Sohail AH, et al.Prior Bariatric Surgery is Associated with a Reduced Risk of Poor Outcomes in COVID-19: Propensity Matched Analysis of a Large Multi-institutional Research Network[J]. Obes Surg, 2022, 32(2): 237-244.
[16] Chen G, Mainous A, Ayzengart A, et al.Association Between Bariatric Surgery and Severe COVID-19 Outcomes in Florida[J]. Obes Surg, 2022, 32(11): 3807-3810.
[17] Van Der Voort PHJ, Moser J, Zandstra DF, et al. Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional study and a pathophysiological framework on the role of fat tissue[J]. Heliyon, 2020, 6(8): e04696.
[18] Bhatraju PK, Ghassemieh BJ, Nichols M, et al.Covid-19 in Critically Ill Patients in the Seattle Region - Case Series[J]. N Engl J Med, 2020, 382(21): 2012-2022.
[19] Chetboun M, Raverdy V, Labreuche J, et al.BMI and pneumonia outcomes in critically ill covid-19 patients: An international multicenter study[J]. Obesity (Silver Spring), 2021, 29(9): 1477-1486.
[20] Shin SW.Weight and Metabolic Outcomes 12 Years after Gastric Bypass[J]. N Engl J Med, 2018, 378(1): 95.
[21] Alsumali A, Al-Hawag A, Bairdain S, et al.The impact of bariatric surgery on pulmonary function: a meta-analysis[J]. Surg Obes Relat Dis, 2018, 14(2): 225-236.
[22] Caussy C, Wallet F, Laville M, et al.Obesity is Associated with Severe Forms of COVID-19[J]. Obesity (Silver Spring), 2020, 28(7): 1175.
[23] Al-Benna S.Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients[J]. Obes Med, 2020, 19: 100283.
[24] Kristem L, Recamonde-Mendoza M, Cigerza GC, et al.Roux-en-Y Gastric Bypass Downregulates Angiotensin-Converting Enzyme 2 (ACE2) Gene Expression in Subcutaneous White Adipose Tissue: A Putative Protective Mechanism Against Severe COVID-19[J]. Obes Surg, 2021, 31(6): 2831-2834.
[25] Moradpour G, Amini M, Moeinvaziri N, et al.Bariatric Surgery and COVID-19: What We Have Learned from the Pandemic in Iran: a Retrospective Observational Cohort Study[J]. Obesity Surgery, 2022, 32(1): 18-25.
[26] Yu HH, Qin C, Chen M, et al.D-dimer level is associated with the severity of COVID-19[J]. Thromb Res, 2020, 195: 219-225.
[27] Rostami M, Mansouritorghabeh H.D-dimer level in COVID-19 infection: a systematic review[J]. Expert Rev Hematol, 2020, 13(11): 1265-1275.
[28] Zeng F, Huang Y, Guo Y, et al.Association of inflammatory markers with the severity of COVID-19: A meta-analysis[J]. Int J Infect Dis, 2020, 96: 467-474.
[29] De Leeuw AJM, Oude Luttikhuis MAM, Wellen AC, et al.Obesity and its impact on COVID-19[J]. J Mol Med (Berl), 2021, 99(7): 899-915.
[30] Moschen AR, Molnar C, Geiger S, et al.Anti-inflammatory effects of excessive weight loss: potent suppression of adipose interleukin 6 and tumour necrosis factor alpha expression[J]. Gut, 2010, 59(9): 1259-1264.
[31] Holdstock C, Lind L, Engstrom BE, et al.CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects[J]. Int J Obes (Lond), 2005, 29(10): 1275-1280.
[32] Frikke-Schmidt H, Zamarron BF, O'rourke RW, et al. Weight loss independent changes in adipose tissue macrophage and T cell populations after sleeve gastrectomy in mice[J]. Mol Metab, 2017, 6(4): 317-326.
[33] Zhang H, Wang Y, Zhang J, et al.Bariatric surgery reduces visceral adipose inflammation and improves endothelial function in type 2 diabetic mice[J]. Arterioscler Thromb Vasc Biol, 2011, 31(9): 2063-2069.
[34] Chen PY, Lu CW, Lee YH, et al.Reduced risk of pneumonia and influenza infection after bariatric surgery: a retrospective cohort study among patients with nondiabetic obesity in Taiwan[J]. Surg Obes Relat Dis, 2023, 19(10):1169-1176.