The Impact of Obesity on Disease Severity and Outcomes Among Hospitalized Children With - COVID-19
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RESEARCH ARTICLE
The Impact of Obesity on Disease Severity and
Outcomes Among Hospitalized Children With
COVID-19
Sandeep Tripathi, MD, MS,a Amy L Christison, MD,b Emily Levy, MD,c Jeremy McGravery, MS,d Aysun Tekin, MD,c Dawn Bolliger, BS, MLT,d
Vishakha K. Kumar, MD, MBA,e Vikas Bansal, MD, MPH,c Kathleen Chiotos, MD,f Katja M. Gist, M.D,g Heda R. Dapul, MD,h Utpal S. Bhalala, MD,i
Varsha P Gharpure, MD,j Julia A. Heneghan, MD,k Neha Gupta, MD,l Erica C. Bjornstad, MD, PhD, MPH,m Vicki L Montgomery, M.D,n Allan Walkey, MD,o
Rahul Kashyap, MBBS, MBA,c Grace M. Arteaga, MDc On Behalf of the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness
Universal Study (VIRUS): COVID-19 Registry Investigator Group
ABSTRACT OBJECTIVE: To describe the impact of obesity on disease severity and outcomes of coronavirus
disease 2019 (COVID-19) among hospitalized children.
METHODS: This retrospective cohort study from the Society of Critical Care Medicine Viral
a
Children's Hospital of Respiratory Illness Universal Study registry included all children hospitalized with COVID-19 from
Illinois, OSF Saint Francis
Medical Centre, Peoria, March 2020 to January 2021. Obesity was defined by Centers for Disease Control and Prevention
Illinois; bUniversity of BMI or World Health Organization weight for length criteria. Critical illness definition was adapted
Illinois College of
Medicine, Peoria, Illinois; from National Institutes of Health criteria of critical COVID. Multivariate mixed logistic and linear
c
Mayo Clinic, Rochester, regression was performed to calculate the adjusted odds ratio of critical illness and the adjusted
Minnesota; dOSF Saint
Francis Medical Centre,
impact of obesity on hospital length of stay.
Peoria, Illinois; eSociety of
Critical Care Medicine, RESULTS: Data from 795 patients (96.4% United States) from 45 sites were analyzed, including 251
Mount Prospect, Illinois;
f
(31.5%) with obesity and 544 (68.5%) without. A higher proportion of patients with obesity were
Children's Hospital of
Philadelphia, Philadelphia,
adolescents, of Hispanic ethnicity, and had other comorbidities. Those with obesity were also more
Pennsylvania; gAnschutz likely to be diagnosed with multisystem inflammatory syndrome in children (35.7% vs 28.1%, P =
Medical Campus,
University of Colorado,
.04) and had higher ICU admission rates (57% vs 44%, P < .01) with more critical illness (30.3% vs
Aurora, Colorado; 18.3%, P < .01). Obesity had more impact on acute COVID-19 severity than on multisystem
h
Hassenfeld Children's inflammatory syndrome in children presentation. The adjusted odds ratio for critical illness with
Hospital at New York
University Langone, New obesity was 3.11 (95% confidence interval: 1.8–5.3). Patients with obesity had longer adjusted length of
York City, New York; iThe stay (exponential parameter estimate 1.3; 95% confidence interval: 1.1–1.5) compared with patients
Children's Hospital of San
Antonio, Baylor College of without obesity but did not have increased mortality risk due to COVID-19 (2.4% vs 1.5%, P = .38).
Medicine; San Antonio,
Texas; jAdvocate CONCLUSION: In a large, multicenter cohort, a high proportion of hospitalized children from
Children's Hospital, Park COVID-19 had obesity as comorbidity. Furthermore, obesity had a significant independent
Ridge, Illinois; kUniversity
of Minnesota Masonic association with critical illness.
Children’s Hospital,
Minneapolis, Minnesota;
l
College of Medicine,
University of Oklahoma,
Oklahoma City, Oklahoma;
m
University of Alabama at www.hospitalpediatrics.org
Birmingham, Birmingham, DOI:https://doi.org/10.1542/hpeds.2021-006087
Alabama; nUniversity of Copyright © 2021 by the American Academy of Pediatrics
Louisville and Norton
Children’s Hospital Address correspondence to Sandeep Tripathi, MD, MS, Pediatric Intensive Care OSF Saint Francis Medical Centre, Children's Hospital of
Louisville, Louisville, Illinois 540, Glen Oak Ave, Peoria IL 61637. E-mail: sandeept@uic.edu
Kentucky; and oSchool of
HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154-1663; Online, 2154-1671).
Public Health, Boston
University, Boston, A complete list of study group members is included in the Acknowledgments. These investigators served as collaborators and site
Massachusetts investigators and should be indexed in PubMed as collaborative coauthors on this manuscript.
HOSPITAL PEDIATRICS Volume 11, Issue 11, November 2021 e297
Downloaded from www.aappublications.org/news by guest on November 6, 2021Coronavirus disease 2019 (COVID-19), the METHODS neonate (#28 days), infant (28 days to
replacement therapy (acute dialysis or nonnormal distribution, LOS was log- were significantly older (13 [7.0–16.0] vs
continuous renal replacement therapy). transformed, and parameter estimates 5.3 [0.8–13.0] years, P < .01), with more
This classification was modified from the and CIs were exponentiated. LOS analysis adolescents composing the group with
National Institutes of Health (NIH) was initially performed after the inclusion obesity compared with the group without
definition of critical COVID-1926 and was of ICU admission status, diagnosis of MIS- (57.4% [144 of 251] vs 30.5% [166 of
previously described by our group.2 C, critical illness, and involvement of 544], P < .01). There was no difference
multiple organ systems because of their in the sex or race distribution among the
Statistical Analysis potential impact on the LOS. Mediator 2 groups; however, there was a much
Standard descriptive statistics were analysis as described by Baron and higher proportion of patients of Hispanic
performed for continuous and categorical Kenny29 indicated at least partial ethnicity in patients with obesity (47.8%
variables and reported as median with mediation of the impact of obesity on LOS [108 of 251] vs 32.9% [158 of 544], P <
interquartile range (IQR) and number with by these variables. These variables were .01). Patients from the United States
percentages. The nonparametric Wilcoxon thus excluded from the linear regression made up 96.4% (767 of 795) of the total
rank test and v2/Fisher’s exact test were model presented. Complete mediator cohort, with a higher proportion of
used as appropriate. Multivariable logistic analysis for the LOS model is provided in patients from the United States in the
regression was performed to assess the Supplemental Table 7. Patients with obese category (99.2% [249 of 251] vs
risk factors associated with critical illness hospital mortality (n = 14) were excluded 95.2% [518 of 544]). Patients with obesity
for the whole cohort and independently from the LOS multivariable analysis. were more likely to have a diagnosis of
for patients with obesity. The odds ratio Models’ goodness of fit was assessed by MIS-C as opposed to acute COVID-19
and 95% CI were calculated. A mixed evaluating the residual plots. All statistical (35.7% [85 of 251] vs 28.1% [147 of 544],
logistic regression that included a random analysis was conducted by using JMP (v P = .04) and were more likely to have
effect for the site was used to determine 16.0; SAS Institute, Inc, Cary, NC) and an $3 organ system involvement at
potential risk factors associated with an open-source statistical program R (V presentation (61.4% [154 of 251] vs
increased likelihood of critical illness after 4.0.0). A P valuepatients $12 years (Fig 2). Separate
analysis for factors associated with
critical illness among the cohort with
obesity (n = 251) revealed that the
presence of $ 2 comorbidities was
marginally associated with the critical
illness (aOR: 1.90; 95% CI: 1.01–3.58, P =
.05) (Supplemental Table 13). On
multivariable linear regression including
the factors described above (with the
addition of country), the presence of
obesity was associated with a 30% longer
hospital LOS (exponentiated parameter
estimate: 1.3; 95% CI: 1.1–1.5), P < .01
(Supplemental Table 14).
Disease Course and Outcomes of
MIS-C and Acute COVID-19 Among
Patients With Obesity
Among the 528 patients with acute COVID-
19, 28.9% (153 or 528) had obesity.
Patients with obesity in this cohort were
older (median age 13.2 vs 4 years, P <
.001), more likely to be Hispanic, and had
more comorbidities. A higher proportion
of those with obesity and acute COVID-19
had critical illness (22% vs 11%, P = .001),
required ICU admission (50% vs 33%, P <
.001) and/or mechanical ventilation (13%
FIGURE 1 Patient selection flow diagram.
vs 6.7%, P = .01) ,and had longer hospital
LOS (3.8 [IQR: 2.0–7.3] days versus 2.8
[1.5–5.9] days, P = .004) (Supplemental
critical illness related to COVID-19 (30.3% Risk Factors for Critical Illness and Table 15). In contrast, although a higher
[76 of 251] vs 18.3% [100 of 544], P < .01). Hospital LOS proportion of patients with MIS-C had
There was a greater need for various obesity (36.6%, 85/232), there was no
By using a multivariate mixed logistic
organ support interventions, including significant difference in critical illness, ICU
regression analysis adjusting for
mechanical ventilation, inotropes, and admission, or mechanical ventilation rate
covariates including age, race, ethnicity,
extracorporeal life support (ECLS), in in patients with MIS-C with obesity and
and presence of $2 comorbidities, with a
patients with obesity. Among the 5 most compared with those without obesity.
random intercept for the site, obesity was
prominent complications recorded in the However, a similar increased LOS occurred
independently associated with an
registry, only acute kidney injury was among the MIS-C cohort with obesity as
significantly more common in those with increased odds ratio of critical illness
for those with acute COVID-19 (8.0 [IQR:
obesity (12.7% [32 of 251 vs 6.8% [37 of (adjusted odds ratio [aOR]: 3.11 [95% CI:
4.7–10.4] days versus 5.7 [3.1–9.4] days,
544], P < .01). Comparative rates of all 1.84–5.27], P < .01). Other factors
P = .01) (Supplemental Table 16).
complications in the VIRUS registry are significantly associated with critical illness
provided in Supplemental Table 12. The included adolescent age, Black race, and
Comparison of Disease Severity
unadjusted median hospital LOS of $2 comorbidities. A significant interaction
was found between age group and obesity, Among Children and Adolescents in
patients with obesity was longer than
with obesity having less impact on the Different Weight Categories ($ 2
those without obesity (4.8 [IQR: 2.5–8.9] vs
3.5 [IQR: 1.8–6.9], P < .01). There was no likelihood of critical illness as the patient Years)
difference in ICU LOS or the duration of gets older. The adjusted critical illness Comparative analysis across 5 different
the ventilator and other modes of oxygen rate for patients with obesity was 23% for weight categories (underweight to severe
therapy between the 2 groups. (Table 2)TABLE 1 Demographics of the Study Population Category Subcategory Total Cohort (n = 795) Nonobese (n = 544) Obese (n = 251) P Age 8.0 (1.6–14.0) 5.31 (0.83–13.0) 13.0 (7.0–16.0)
TABLE 2 Hospital Course and Outcomes Category Subcategory Total Cohort (n = 795) Nonobese (n = 544) Obese(n = 251) P Categorical variables Hospital mortality — 14 (1.7) 8 (1.5) 6 (2.4) .38 ICU admission — 382 (48.0) 239 (43.9) 143 (56.9)
TABLE 3 Comparison of Demographics, Comorbidities, and Outcomes in Different BMI Categories (Children $2 y Only) Category Subcategory Underweight (n = 45) Normal (n = 231) Overweight(n = 79) Obese (n = 120) Severely Obese (n = 107) Pa Age 7 (4–12.5) 11 (5.4–15) 11.5 (8–15) 12.9 (7.8–16) 14 (10.9–16)
poor prognosis with adult obesity in the hospitalized with acute COVID-19. Salvagio Campbell, Cathleen Wilson, Patrick
youngest age group with progressive Hospitalized children with obesity are Rivers, Jonathan Brinks, Mokenge Ndiva
decreases in higher age groups. To the more likely to have critical illness than Mongoh, Boris Gilson (Banner University
best of our knowledge, we are the first to hospitalized children without obesity. Medical Center-Tucson); Valerie C. Danesh,
report this interaction in the pediatric Although adolescents made up a higher Gueorgui Dubrocq, Amber L. Davis, Marissa
population. proportion of patients with obesity, J Hammers, ill M. McGahey, Amanda C.
This study has limitations inherent to adolescent age was itself an independent Farris, Elisa Priest, Robyn Korsmo, Lorie
those with other retrospective registry risk for critical illness, thereby potentially Fares, Kathy Skiles, Susan M. Shor, Kenya
analyses. A complete case analysis such decreasing the impact of obesity on Burns, Corrie A Dowell, Gabriela “Hope”
as ours assumes data are missing critical illness within this group. Gonzales, Melody Flores, Lindsay Newman,
completely at random. If this assumption Debora A Wilk, Jason Ettlinger, Jaccallene
is not met, there is potential for bias. The Acknowledgments Bomar, Himani Darji, Alejandro Arroliga,
VIRUS registry employs robust data Society of Critical Care Medicine Discovery Alejandro C Arroliga, Corrie A. Dowell,
missingness review and cross-validation Viral Infection and Respiratory Illness Gabriela Hope Conzales, Melody Flores,
process with a weekly report to the Universal Study (VIRUS): COVID-19 Registry Lindsay Newman, Debora A. Wilk, Jason
investigators. However, there is still a Ettlinger, Himani Darji, Jaccallene Bomar
Investigator Group Coauthors:
possibility of data entry errors. Because of (Baylor Scott & White Health); Paras B.
From Croatia: Tanja Kovacevic, Josko Khandhar, Elizabeth Kring (Beaumont
the limitation of the deidentified data set, Markic, Tatjana Catipovic Ardalic, Branka
further source verification could not be Children's Hospital); Aaron S. Miller, Edwin
Polic, Ivo Ivic, Dominko Carev, Robert L. Anderson, Rosemary Nagy, Ravali R. Inja
conducted for this analysis. A high
Glavinic (University Hospital of Split); from (Cardinal Glennon Children's Hospital);
proportion of hospitalized children have
India: Umamaheswara Raju, Janaki Grace Arteaga, Emily Levy, Aysun Tekin,
incidental positive polymerase chain
Manduva, Naresh Kolakani, Shreeja Sripathi, Rahul Kashyap, Mayank Sharma, Vikas
reaction of SARS-CoV-244,45; these patients
Sheetal Chaitanya (Gandhi Medical College Bansal, Neha Deo, Shahraz Qamar, Romil
were excluded from the registry. However,
and Hospital, Hyderabad); Surapaneni Singh, Marija Bogojevic (Children’s Center,
the distinction of incidental diagnosis was
Krishna Mohan, Ekambaram Jyothisree Mayo Clinic Rochester); Kathleen Chiotos,
made by the site investigators. Because of
(Panimalar Medical College Hospital & Allison M. Blatz, Giyoung Lee, Ryan H.
the evolving understanding of the varied
Research Institute); from Pakistan: Sidra Burnett, Guy I. Sydney, Danielle M. Traynor
COVID-19 presentations, this may have
Ishaque, Ali Faisal Saleem, Naveed Ur (Children's Hospital of Philadelphia); Margit
resulted in variability of this
Rehman Siddiqui, Salima Sherali, Yasmin Kaufman, Gregg Lobel, Nisha Gandhi, Amr
characterization leading to a slight over
Hashwani, Shafia Ishaque (The Aga Khan Abdelaty, Elizabeth Shaji, Kiana Lim, Juan
and/or under the inclusion of patients.
University Hospital); Muhammad Sohaib Marte, Dani Ashley Sosa (Englewood Health);
Variables chosen for the logistic and
Asghar, Mashaal Syed, Syed Anosh Ali Naqvi Smith F. Heavner-Sullivan, Prera J. Roth,
linear regression models were based on
(Dow University Hospital); from Saudi Banu Sivaraj, Haley Fulton, Madison G Herin,
the current theoretical understanding of
Arabia: Mohammed A Almazyad, Mohammed Marissa Crum, Morgan E. Fretwell, Emily-
the risk. There might be other variables
I Alarifi, Jara M Macarambon, Ahmad Rose Zhou (Greenville Memorial Hospital);
associated with critical illness or longer
Abdullah Bukhari, Hussain A. Albahrani, Kazi Heda R. Dapul, Sourabh Verma, Alan Salas,
LOS that were not included in our model
N Asfina, Kaltham M Aldossary (King Saud Ariel Daube, Michelle Korn, Michelle
and could confound the association of
University); from United States: Varsha P Ramirez, Logi Rajagopalan, Laura Santos
obesity. A composite index such as critical
Gharpure, Usman Raheemi (Advocate (Hassenfeld Children's Hospital at NYU
illness gives equal weightage to every
Children's Hospital, IL); Suzanne Barry, Langone); Asher G Bercow, Mark Shlomovich
component of the index, each of which
may not be similar from a patient Christopher Woll, Gregory Wu, Erin Carrole, (Jacobi Medical Center); J.H. Steuernagle
perspective (eg, mortality and noninvasive Kathryn Burke, Mustafa Mohammed (Albany (Johns Hopkins School of Medicine); Melissa
ventilation are provided the same rank). Medical Center); Catherine A. St Hill, Roman Thomas, Sarah Morris, Jennifer Nason
Although derived from NIH classification, R. Melamed, David M. Tierney, Love A. Patel, (KCPCRU at Norton Children’s Hospital
the critical illness definition uses objective Vino S. Raj,Barite U. Dawud, Narayana Louisville); Manoj K Gupta, Franscene E.
parameters to identify patients and may Mazumder, Abbey Sidebottom, Alena M. Oulds, Akshay Nandavar (Lincoln Medical
miss some patients who would otherwise Guenther, Benjamin D. Krehbiel, Nova J. Center); Andy Y. Wen, Allie DaCar (Lucile
qualify for NIH classification of critical Schmitz, Stacy L. Jepsen (Allina Health: Packard Children's Hospital Stanford); Julia
illness and vice versa. Abbott Northwestern Hospital, United A. Heneghan, Ronald A. Reilkoff, Sarah
Hospital, and Mercy Hospital in Minnesota); Eichen, Lexie Goertzen, Scott Rajala,
CONCLUSIONS Katherine Irby, Ronald C. Sanders Jr, Glenda Ghislaine Feussom, Ben Tang (M Health-
We report obesity as a risk factor for Hefley (Arkansas Children's Hospital); Fairview, University of Minnesota); Amy B.
disease severity in pediatric patients Jarrod M Mosier, Karen Lutrick, Beth Christie, Dennis W. Ashley, Rajani Adiga
e304 TRIPATHI et al
Downloaded from www.aappublications.org/news by guest on November 6, 2021(Medical Center Navicent Health); Prithvi (SUNY Upstate Medical University); Neha Omalay, Haleh Hashemighouchani, Julie S.
Sendi, Meghana Nadiger, Balagangadhar Gupta, Brent R Brown, Tracy L Jones, Cupka, Matthew M Ruppert (University of
Totapally (Nicklaus Children’s Hospital); Kassidy Malone, Lauren A Sinko, Amy B Florida Health Shands Hospital); Patrick
Bhagat S. Aulakh, Sandeep Tripathi, Harrell, Shonda C Ayers, Lisa M Settle, W. McGonagill, Colette Galet, Janice
Jennifer A. Bandy, Lisa M. Kreps, Dawn R. Taylor J Sears (The Children's Hospital at Hubbard, David Wang, Lauren Allan,
Bollinger, Jennifer A. Bandy (OSF Saint OU Medicine); Utpal S. Bhalala, Joshua Aditya Badheka, Madhuradhar Chegondi
Francis Medical Center); Shina Menon, Kuehne, Melinda Garcia, Morgan Beebe, (University of Iowa Carver College of
John K McGuire, Deana Rich (Seattle Heather Herrera (The Children's Hospital Medicine); Murtaza Akhter, Rania Abdul
Children's Hospital); Harry L. Anderson, of San Antonio, Baylor College of Rahman, Mary Mulrow (Valleywise Health,
III, Dixy Rajkumar, Ali Abunayla, Jerrilyn Medicine); Katherine A. Belden, Michael formerly Maricopa Medical Center);
Heiter (St Joseph Mercy Ann Arbor, Ann Baram, Devin M. Weber, Rosalie DePaola, Markos G. Kashiouris, Tamas Gal, Manasi
Arbor); Howard A. Zaren, Stephanie J. Yuwei Xia, Hudson Carter, Aaron Tolley, Mahashabde, Alexandra Vagonis, Rebecca
Smith, Grant C. Lewis, Lauren Seames, Mary Barletta (Thomas Jefferson Uber, Haseeb Mahmud, Stefan Leightle,
Cheryl Farlow, Judy Miller, Gloria University Hospital); Erica C. Bjornstad, Zoe Zhang, Nicole Vissichelli, Oliver
Broadstreet (St Joseph's Candler Health Nancy M. Tofil, Scott House, Isabella Karam, Alia O'Meara, Heloisa De Carvalho,
System); John Lin, Cindy Terrill, Brock Aldana (University of Alabama at Katie Rocawich (Virginia Commonwealth
Montgomery, Sydney Reyes, Summer Birmingham); Casey W Stulce, Grace University Medical Center); Ashish K
Reyes, Alex Plattner (St Louis Children’s Chong, Ahmeneh Ghavam, Anoop Khanna, Lynne Harris, Bruce Cusson,
Hospital); Anthony Martinez, Micheal Mayampurath (University of Chicago); Jacob Fowler, David Vaneenenaam, Glen
Allison, Aniket Mittal, Rafael Ruiz, Aleta Katja M. Gist, Imran A Sayed, John McKinney, Imoh Udoh, Kathleen Johnson
Skaanland, Robert Ross (StAgnes Brinton, Larisa Strom (University of (Wake Forest University School of
Hospital); William Marx, Ioana Amzuta, Colorado Anschutz Medical Campus); Azra Medicine; Wake Forest Baptist Health
Asad J. Choudhry, Mohammad T. Azam Bihorac, Tezcan Ozrazgat Baslanti, George Network).
Access to deidentified patient data are dependent on guidelines of the VIRUS registry. Further information about access to de-identified data from the VIRUS
registry can be requested from Dr Vishakha Kumar at vkumar@sccm.org
This trial has been registered at www.clinicaltrials.gov (identifier NCT 04323787).
Dr Tripathi designed the study, designed the data collection instruments, obtained data from the Viral Respiratory Illness Universal Study (VIRUS) registry,
conducted the initial analysis and interpretation, and supervised the literature search and drafted the initial manuscript and the final manuscript; Dr Arteaga
conceptualized the study, assisted in the literature search and drafting of the initial manuscript, and reviewed the final manuscript and provided critical input
for intellectual content; Dr Christison and Dr Levy assisted in the concept and design of the study, literature search, and drafting of the initial manuscript; Mr
McGarvey performed statistical analysis and interpretation for the manuscript; Dr Tekin, Ms Bolliger, Dr Chiotos, Dr Gist, Dr Dapul, Dr Bhalala, Dr Gharpure,
Dr Heneghan, Dr Gupta, Dr Bjornstad, and Dr Montgomery supervised or performed data collection at their sites and assisted in the review and provided
critical input for intellectual content; Dr Kashyap, Dr Walkley, and Dr Kumar are the principal investigators of the VIRUS registry, conceptualized and designed
the data collection instruments (REDCap) for the registry, and reviewed and provided critical input for intellectual content; Dr Bansal assisted in data
collection and extraction for this manuscript from the VIRUS registry and reviewed the final manuscript and provided necessary inputs in design and analysis;
and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FINANCIAL DISCLOSURE: E.R.L. receives funding from the Centers for Disease Control and Prevention (CDC) (Subcontract of Federal Contract: 75D30120C07725)
and the National Institute of Allergy and Infectious Diseases (National Institute of Allergy and Infectious Diseases Federal Contract: AI144301). They had no
influence on the acquisition, analysis, interpretation, and reporting of pooled data for this manuscript. K.C. funded by Agency for Healthcare Research and
Quality [K12-HS026393]. No conflict of interest. R.K. receives funding from the National Institutes of Health/National Heart, Lung and Blood Institute: R01HL
130881, UG3/UH3HL 141722; Gordon and Betty Moore Foundation Janssen Research & Development, LLC; and royalties from Ambient Clinical Analytics. Inc. They
had no influence on the acquisition, analysis, interpretation, and reporting of pooled data for this manuscript. V.K.K. receives funding from the Gordon and
Betty Moore Foundation, CDC Foundation through the University of Washington, and Janssen Research & Development, LLC. They had no influence on the
acquisition, analysis, interpretation, and reporting of pooled data for this manuscript. U.S.B is currently funded by National Institutes of Health (Site-principal
investigator for Stress Hydrocortisone in Pediatric Septic Shock - R01HD096901), The Children's Hospital of Philadelphia (Site-PI for Pediatric Resuscitation
Quality Collaborative - PediResQ), Voelcker Pilot Grant (principal investigator for a project on Pre-Arrest Electrocardiographic Changes), The Children's Hospital
of San Antonio Endowed Chair Funds for ancillary projects related to SCCM VIRUS (COVID-19) Registry and SCCM VIRUS EMR automation pilot. No conflict of
interest. A.L.C. is funded by the National Institute of Allergy and Infectious Disease: U01AI138907. All other authors have indicated they have no financial
relationships relevant to this article to disclose.
FUNDING: The registry is funded in part by the Gordon and Betty Moore Foundation and Janssen Research & Development, LLC. Funding sources had no
influence on the acquisition, analysis, interpretation, and reporting of pooled data for this manuscript.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
In this study, we leverage data from the Society of Critical Care Medicine VIRUS registry on 795 patients from 45 sites to describe the impact of obesity on
disease severity with COVID-19 in children.
HOSPITAL PEDIATRICS Volume 11, Issue 11, November 2021 e305
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2016;137(3):e20152035 et al; Overcoming COVID-19 Investigators. hpeds.2021-006001
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Downloaded from www.aappublications.org/news by guest on November 6, 2021The Impact of Obesity on Disease Severity and Outcomes Among Hospitalized
Children With COVID-19
Sandeep Tripathi, Amy L Christison, Emily Levy, Jeremy McGravery, Aysun Tekin,
Dawn Bolliger, Vishakha K. Kumar, Vikas Bansal, Kathleen Chiotos, Katja M. Gist,
Heda R. Dapul, Utpal S. Bhalala, Varsha P Gharpure, Julia A. Heneghan, Neha Gupta,
Erica C. Bjornstad, Vicki L Montgomery, Allan Walkey, Rahul Kashyap and Grace
M. Arteaga
Hospital Pediatrics originally published online June 24, 2021; originally published
online June 24, 2021;
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2021-006087
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Downloaded from www.aappublications.org/news by guest on November 6, 2021The Impact of Obesity on Disease Severity and Outcomes Among Hospitalized
Children With COVID-19
Sandeep Tripathi, Amy L Christison, Emily Levy, Jeremy McGravery, Aysun Tekin,
Dawn Bolliger, Vishakha K. Kumar, Vikas Bansal, Kathleen Chiotos, Katja M. Gist,
Heda R. Dapul, Utpal S. Bhalala, Varsha P Gharpure, Julia A. Heneghan, Neha Gupta,
Erica C. Bjornstad, Vicki L Montgomery, Allan Walkey, Rahul Kashyap and Grace
M. Arteaga
Hospital Pediatrics originally published online June 24, 2021; originally published
online June 24, 2021;
The online version of this article, along with updated information and services, is
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http://hosppeds.aappublications.org/content/early/2021/10/05/hpeds.2021-006087
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