. 2023 May 24;2023(5):CD015201. doi: 10.1002/14651858.CD015201

Zhu 2020.

*Study characteristics*
Notes	English title Association of obesity and its genetic predisposition with the risk of severe COVID‐19: analysis of population‐based cohort data Study setting Start of study recruitment (MM/YYYY): 03/2020 End of study recruitment (MM/YYYY): 04/2020 Study design: Prospective cohort Study centre(s): Multiple centres/clinics/areas within a country Number of centres, clinics or areas: NR Study setting: Inpatient Number of participants recruited: 641 Sampling method: Consecutive participants Participants Female participants (absolute number): 278 Age measure, value: Mean (SD), NR Inclusion criteria: NR Exclusion criteria: NR Smoking frequency: NR Diabetes frequency: 61 Hypertension frequency: NR Cardiovascular disease frequency: NR Asthma frequency: NR Chronic obstructive pulmonary disease frequency: NR Other pulmonary disease frequency: NR Immunosuppression frequency: NR Chronic kidney disease frequency: NR Cancer frequency: NR Steroid administration frequency: NR Supplemental oxygen administration frequency: NR Other treatments (frequency): NR Prognostic factor(s) Study’s definition for obesity: Underweight (< 18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), class I obesity (30.0–34.9 kg/m²), class II obesity (35.0–39.9 kg/m²), and class III obesity (≥ 40.0 kg/m² [severe obesity]) The time when obesity has been measured: Before disease or right at presentation Main variable used for determination of obesity: BMI Threshold used for definition: BMI ≥ 30 kg/m² Obesity frequency (absolute number): 226 Prognostic factor(s): 30 < BMI < 35 (obesity class 1) 35 < BMI < 40 (obesity class 2) BMI > 40 (obesity class 3) Outcome(s) Severe COVID Outcome (prognostic factor) Severe COVID (30 < BMI < 35 (obesity class 1)) Follow‐up Number of patients followed completely for the outcome: 641 Number of obese patients followed completely for the outcome: 226 Number of non‐obese patients followed completely for the outcome: 415 Univariable unadjusted analysis for obesity Effect measure for obesity: NR Effect measure value (95% CI), P value: NR Multivariable analysis for obesity Modelling method: Logistic regression The set of prognostic factors used for adjustment: Age, CVD, ethnicity, DM, HTN, sex Effect measure for obesity: Odds ratio Effect measure value (95% CI), P value: 1.08 (0.55, 1.66), 0.78 Outcome (prognostic factor) Severe COVID (35 < BMI < 40 (obesity class 2)) Follow‐up Number of patients followed completely for the outcome: 641 Number of obese patients followed completely for the outcome: 226 Number of non‐obese patients followed completely for the outcome: 415 Univariable unadjusted analysis for obesity Effect measure for obesity: NR Effect measure value (95% CI), P value: NR Multivariable analysis for obesity Modelling method: Logistic regression The set of prognostic factors used for adjustment: Age, CVD, ethnicity, DM, HTN, sex Effect measure for obesity: Odds ratio Effect measure value (95% CI), P value: 1.88 (1.26, 2.51), 0.05 Outcome (prognostic factor) Severe COVID (BMI > 40 (obesity class 3)) Follow‐up Number of patients followed completely for the outcome: 641 Number of obese patients followed completely for the outcome: 226 Number of non‐obese patients followed completely for the outcome: 415 Univariable unadjusted analysis for obesity Effect measure for obesity: NR Effect measure value (95% CI), P value: NR Multivariable analysis for obesity Modelling method: Logistic regression The set of prognostic factors used for adjustment: Age, CVD, ethnicity, DM, HTN, sex Effect measure for obesity: Odds ratio Effect measure value (95% CI), P value: 1.22 (0.23, 2.21), 0.69

Item	Authors' judgement	Support for judgement
Study Participation	Yes	Appendix 3
Study Attrition Severe COVID	Yes	Appendix 3
Prognostic Factor Measurement	Yes	Appendix 3
Outcome Measurement Mortality	Unclear	Appendix 3
Confounding Bias Severe COVID	Yes	Appendix 3
Statistical Analysis Bias	Unclear	Appendix 3

ACEI: Angiotensin‐converting enzyme inhibitor AKI: Acute kidney injury ALB: Albumin ALC: Absolute lymphocyte count ALT: Alanine transaminase APACHEII: Acute Physiology and Chronic Health Evaluation II ARB: Angiotensin receptor blocker ARDS: Acute respiratory distress syndrome ASAT: Aspartate aminotransferase AST: Aspartate aminotransferase AZI: Azithromycin BAL: Mini‐bronchoalveolar lavage BID: Twice daily BMI: Body mass index BP: Blood pressure BUN: Blood urea nitrogen CAD: Coronary artery disease CBC: Complete blood count CCI: Charlson Comorbidity Index CD4: Cluster of differentiation 4 CHD: Coronary heart disease CHF: Congestive heart failure CI: Confidence interval CK: Creatine kinase CKD: Chronic kidney disease CMO: Comfort measures only COPD: Chronic obstructive pulmonary disease COVID‐19: Coronavirus disease 2019 CR: Creatinine CRP: C‐reactive protein CT: Computed tomography CTD: Connective tissue diseases cTnl: Cardiac troponin CVD: Cardiovascular disease DBP: Diastolic blood pressure D‐D: D‐dimer DLP: Dyslipidaemia DNI: Do not intubate DNR: Do not resuscitate DM: Diabetes mellitus DMT: Disease modifying therapies ECMO: Extracorporeal membrane oxygenation ED: Emergency department EDSS: Expanded disability status scale eGFR: Estimated glomerular filtration rate ER: Emergency room ESF: Enhanced surveillance form ESRD: End stage renal disease FIB‐4: Fibrosis Index Based on 4 Factors fiO2: Fraction of inspired oxygen FBG: Fasting blood glucose FPG: Fasting plasma glucose GCS: Glasgow Coma scale GLM: Generalised linear model GLP1‐RA: Glucagon‐like peptide‐1 receptor agonists GP: General practice Hb: Haemoglobin HbA1c: Glycated haemoglobin HCQ: Hydroxychloroquine HF: Heart failure HFNC: High‐flow nasal cannula HIV: Human immunodeficiency virus HLP: Hyperlipidaemia hs‐CRP: High‐sensitivity C‐reactive protein HTN: Hypertension IA: Inflammatory arthritis ICD‐10(‐CM): International Classification of Diseases, Tenth Revision, Clinical Modification ICU: Intensive care unit IG: Immature granulocytes IHD: Ischaemic heart disease IL‐6: Interleukin 6 IMV: Invasive mechanical ventilation INR: International normalised ratio IQR: Interquartile range IRMD: Rheumatic and inflammatory diseases IS: Immunosuppression KPSC: Kaiser Permanente Southern California LDH: Lactate dehydrogenase LDL(‐c): Low‐density lipoprotein cholesterol LVEF: Left ventricular ejection fraction LYM: Lymphocytes MAD: Median absolute deviation MDRD: Modification of Diet in Renal Disease MDS: Minimum dataset MEDEA: Mortalidad en áreas pequeñas Españolas y Desigualdades Socioeconómicas y Ambientales MS: Multiple sclerosis NA: Not applicable NDI: Neighbourhood Deprivation Index NEUT‐RI: Neutrophil reactivity intensity NLR: Neutrophil‐lymphocyte ratio NM: Neuromuscular NPPV: Noninvasive positive‐pressure ventilation NR: Not reported NRB: Non‐rebreather NS: Not significant O2: Oxygen PAD: Peripheral arterial disease PaO2: Partial pressure of oxygen PaCO2: Partial pressure of carbon dioxide PCR: Polymerase chain reaction PF: Ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen P/F: Ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen PIN: Personal identification number PLT: Platelets PMR: Polymyalgia rheumatica PsA: Psoriatic arthritis PT: Prothrombin time QSOFA: Quick Sepsis Related Organ Failure Assessment RNA: Ribonucleic acid RR: Respiratory rate RTB: Population Statistics of Sweden RT‐PCR: Reverse transcription polymerase chain reaction SAPS3: Simplified Acute Physiology Score 3 SIRI: Influenza and Virus Infection Registry SpO2: Oxygen saturation SRF: Severe respiratory failure WHO: World Health Organization