{"doi":"10.1038/s41366-021-01017-8","title":"The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study","abstract":"<jats:title>Abstract</jats:title><jats:sec>\n                <jats:title>Background</jats:title>\n                <jats:p>Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Methods</jats:title>\n                <jats:p>1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Results</jats:title>\n                <jats:p>The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02–1.97 and 2.78, 95% CI 1.83–4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06–2.74, and 2.62, 95% CI 1.65–4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42–0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03–2.42). In patients with a BMI ≥ 25 kg/m<jats:sup>2</jats:sup>, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50–3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Conclusions</jats:title>\n                <jats:p>EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.</jats:p>\n              </jats:sec>","journal":"International Journal of Obesity","year":2022,"id":631184,"datarank":0.41588830833596724,"base_score":2.772588722239781,"endowment":2.772588722239781,"self_citation_contribution":0.41588830833596724,"citation_network_contribution":0.0,"self_endowment_contribution":0.41588830833596724,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1635628,"name":"Eduardo W. Goicochea-Turcott","orcid":null,"position":1,"is_corresponding":false},{"id":1635629,"name":"Leonardo Mancillas-Adame","orcid":null,"position":2,"is_corresponding":false},{"id":1635630,"name":"Nayely Garibay-Nieto","orcid":null,"position":3,"is_corresponding":false},{"id":1635631,"name":"Malaquías López-Cervantes","orcid":null,"position":4,"is_corresponding":false},{"id":1635632,"name":"Mario E. Rojas-Russell","orcid":null,"position":5,"is_corresponding":false},{"id":1635634,"name":"Lilia V. Castro-Porras","orcid":null,"position":6,"is_corresponding":false},{"id":937199,"name":"Eduardo Gutiérrez-León","orcid":"0000-0001-5833-0932","position":7,"is_corresponding":false},{"id":1635635,"name":"Luis F. Campos-Calderón","orcid":null,"position":8,"is_corresponding":false},{"id":1635636,"name":"Karen Pedraza-Escudero","orcid":null,"position":9,"is_corresponding":false},{"id":1635637,"name":"Karina Aguilar-Cuarto","orcid":null,"position":10,"is_corresponding":false},{"id":1635638,"name":"Eréndira Villanueva-Ortega","orcid":null,"position":11,"is_corresponding":false},{"id":383076,"name":"Joselín Hernández-Ruiz","orcid":"0000-0002-0571-2563","position":12,"is_corresponding":false},{"id":1635641,"name":"Guadalupe Guerrero-Avendaño","orcid":null,"position":13,"is_corresponding":false},{"id":1635643,"name":"Sheyla M. Monzalvo-Reyes","orcid":null,"position":14,"is_corresponding":false},{"id":1635644,"name":"Rafael García-Rascón","orcid":null,"position":15,"is_corresponding":false},{"id":1635645,"name":"Israel N. Gil-Velázquez","orcid":null,"position":16,"is_corresponding":false},{"id":1635646,"name":"Dora E. Cortés-Hernández","orcid":null,"position":17,"is_corresponding":false},{"id":1635647,"name":"Marcela Granados-Shiroma","orcid":null,"position":18,"is_corresponding":false},{"id":1635648,"name":"Brenda G. Alvarez-Rodríguez","orcid":null,"position":19,"is_corresponding":false},{"id":1635649,"name":"Martha L. Cabello-Garza","orcid":"0000-0001-6580-9650","position":20,"is_corresponding":false},{"id":1635650,"name":"Zaira L. González-Contreras","orcid":null,"position":21,"is_corresponding":false},{"id":1635651,"name":"Esteban Picazo-Palencia","orcid":"0000-0002-2456-7955","position":22,"is_corresponding":false},{"id":1635652,"name":"Juana M. Cerda-Arteaga","orcid":null,"position":23,"is_corresponding":false},{"id":1635653,"name":"Héctor R. Pérez-Gómez","orcid":null,"position":24,"is_corresponding":false},{"id":1635654,"name":"Roberto Calva-Rodríguez","orcid":null,"position":25,"is_corresponding":false},{"id":1482881,"name":"Gerardo Sánchez-Rodríguez","orcid":null,"position":26,"is_corresponding":false},{"id":1635655,"name":"Leslie D. Carpio-Vázquez","orcid":null,"position":27,"is_corresponding":false},{"id":1635656,"name":"María A. Dávalos-Herrera","orcid":null,"position":28,"is_corresponding":false},{"id":1635657,"name":"Karla M. Villatoro-de-Pleitez","orcid":null,"position":29,"is_corresponding":false},{"id":1635658,"name":"Melissa D. Suárez-López","orcid":null,"position":30,"is_corresponding":false},{"id":1635659,"name":"María G. Nevárez-Carrillo","orcid":null,"position":31,"is_corresponding":false},{"id":1635660,"name":"Karina Pérez-Alcántara","orcid":null,"position":32,"is_corresponding":false},{"id":1558196,"name":"Roopa Mehta","orcid":"0000-0002-2509-8054","position":33,"is_corresponding":false},{"id":1635661,"name":"Edurne Sandoval Diez","orcid":null,"position":34,"is_corresponding":false},{"id":86124,"name":"Edward W. Gregg","orcid":"0000-0003-2381-6822","position":35,"is_corresponding":false},{"id":876160,"name":"Marcela Rodríguez-Flores","orcid":"0000-0002-6607-4067","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study","abstract":"<jats:title>Abstract</jats:title><jats:sec>\n                <jats:title>Background</jats:title>\n                <jats:p>Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Methods</jats:title>\n                <jats:p>1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Results</jats:title>\n                <jats:p>The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02–1.97 and 2.78, 95% CI 1.83–4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06–2.74, and 2.62, 95% CI 1.65–4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42–0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03–2.42). In patients with a BMI ≥ 25 kg/m<jats:sup>2</jats:sup>, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50–3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight.</jats:p>\n              </jats:sec><jats:sec>\n                <jats:title>Conclusions</jats:title>\n                <jats:p>EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.</jats:p>\n              </jats:sec>","is_dataset_classified":null,"base_score":2.772588722239781,"endowment":2.772588722239781,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"34974543","pmcid":"PMC8873002","openalex_id":"https://openalex.org/W4206452989","authors":[],"funders":[],"total_grants":0,"fwci":1.449,"citation_percentile":0.8272771,"influential_citations":0,"citation_trend":[{"year":2022,"count":5},{"year":2023,"count":2},{"year":2024,"count":2},{"year":2025,"count":6}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://www.nature.com/articles/s41366-021-01017-8.pdf","host_type":"journal"},{"url":"https://www.nature.com/articles/s41366-021-01017-8.pdf","host_type":"publisher"},{"url":"https://www.nature.com/articles/s41366-021-01017-8","host_type":"publisher"},{"url":"https://doi.org/10.1038/s41366-021-01017-8","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/34974543","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/8873002","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC8873002","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC8873002?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["COVID-19 Clinical Research Studies","Bariatric Surgery and Outcomes","Cardiovascular Function and Risk Factors","Adult","Aged","COVID-19","Comorbidity","Female","Hospitalization","Humans","Male","Middle Aged","Obesity","Retrospective Studies","Severity of Illness Index","Treatment Outcome"],"mesh_terms":["COVID-19","Adult","Aged","Female","Hospitalization","Humans","Male","Middle Aged","Obesity","Retrospective Studies","Severity of Illness Index","Comorbidity","Treatment Outcome"],"keywords":["Medicine","Body mass index","Comorbidity","Obesity","Internal medicine","Intubation","Obesity paradox","Stage (stratigraphy)","Coronavirus disease 2019 (COVID-19)","Mechanical ventilation","Charlson comorbidity index","Disease","Surgery","Overweight"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[{"name":"doi"}],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-05T23:01:53.813044Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}