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Biomedicines
Volume 13
Issue 8
10.3390/biomedicines13082009
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Obesity and COVID-19: Pathophysiological Insights and Pulmonary Complications in a Retrospective Cohort Study

by
Cristina Stefania Dumitru
1,
Raul Patrascu
2,*,
Alexia Manole
3,
Ionut Dragos Capraru
4,
Fira-Mladinescu Corneluta
5,
Felicia Manole
6,
Dorin Novacescu
1 and
Flavia Zara
1
1
Department II of Microscopic Morphology, Discipline of Histology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania
2
Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
3
Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
4
Department of Epidemiology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq. Nr. 2, 300041 Timisoara, Romania
5
Hygiene, Department of Microbiology, Center for Study in Preventive Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
6
ENT Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
*
Author to whom correspondence should be addressed.
Biomedicines 2025, 13(8), 2009; https://doi.org/10.3390/biomedicines13082009
Submission received: 11 July 2025 / Revised: 12 August 2025 / Accepted: 13 August 2025 / Published: 18 August 2025
(This article belongs to the Special Issue SARS-CoV-2 Infection: Focus on Pathophysiological Characteristics, Complications and Effects of Vaccinations)
Versions Notes

Abstract

Background/Objectives: Obesity is a major modifier of COVID-19 outcomes, contributing to increased disease severity and complications. This study aimed to assess the impact of obesity on clinical severity, pulmonary involvement, and in-hospital mortality among COVID-19 patients and to identify independent predictors of severe disease. Methods: We conducted a retrospective cohort study of 3005 hospitalized adults with RT-PCR-confirmed COVID-19 between 1 January 2020 and 1 March 2023. Patients were stratified by obesity status (body mass index (BMI) ≥ 30 kg/m2). Clinical, comorbidity, imaging, and laboratory data, as well as vaccination status (vaccinated or unvaccinated), were collected. Multivariate regression and gradient boosting models were used to identify predictors of severe outcomes. Effect estimates are expressed as relative risks (RRs) with 95% confidence intervals (CIs). Results: Obese patients (n = 894) showed significantly higher rates of severe COVID-19 (31.7% vs. 22.4%, p < 0.001) and more extensive lung damage (>50% involvement: 27.9% vs. 22.0%, p < 0.001), with lower admission SpO2 (92.1 ± 4.0% vs. 94.2 ± 3.2%, p < 0.001). Hypoxemia (SpO2 < 90%) was more frequent in obese individuals. The relative risk (RR) for severe disease was 1.41 (95% CI 1.25–1.60), and for >50% lung involvement, it was 1.27 (95% CI 1.11–1.45). Age > 65 years was the strongest predictor of mortality, particularly in non-obese patients. Gradient boosting models outperformed logistic regression (AUC = 0.92 vs. 0.87). Conclusions: Obesity independently predicts severe COVID-19 and pulmonary impairment. These findings support obesity-based risk stratification for clinical management and public health interventions.
Keywords: COVID-19; disease severity; obesity; risk factors; vaccination COVID-19; disease severity; obesity; risk factors; vaccination

Share and Cite

MDPI and ACS Style

Dumitru, C.S.; Patrascu, R.; Manole, A.; Capraru, I.D.; Corneluta, F.-M.; Manole, F.; Novacescu, D.; Zara, F. Obesity and COVID-19: Pathophysiological Insights and Pulmonary Complications in a Retrospective Cohort Study. Biomedicines 2025, 13, 2009. https://doi.org/10.3390/biomedicines13082009

AMA Style

Dumitru CS, Patrascu R, Manole A, Capraru ID, Corneluta F-M, Manole F, Novacescu D, Zara F. Obesity and COVID-19: Pathophysiological Insights and Pulmonary Complications in a Retrospective Cohort Study. Biomedicines. 2025; 13(8):2009. https://doi.org/10.3390/biomedicines13082009

Chicago/Turabian Style

Dumitru, Cristina Stefania, Raul Patrascu, Alexia Manole, Ionut Dragos Capraru, Fira-Mladinescu Corneluta, Felicia Manole, Dorin Novacescu, and Flavia Zara. 2025. "Obesity and COVID-19: Pathophysiological Insights and Pulmonary Complications in a Retrospective Cohort Study" Biomedicines 13, no. 8: 2009. https://doi.org/10.3390/biomedicines13082009

APA Style

Dumitru, C. S., Patrascu, R., Manole, A., Capraru, I. D., Corneluta, F.-M., Manole, F., Novacescu, D., & Zara, F. (2025). Obesity and COVID-19: Pathophysiological Insights and Pulmonary Complications in a Retrospective Cohort Study. Biomedicines, 13(8), 2009. https://doi.org/10.3390/biomedicines13082009

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