Blood glucose and epicardial adipose tissue at the hospital admission as possible predictors for COVID-19 severity.

PURPOSE: To study the possible association of CT-derived quantitative epicardial adipose tissue (EAT) and glycemia at the admission, with severe outcomes in patients with COVID-19. METHODS: Two hundred and twenty-nine patients consecutively hospitalized for COVID-19 from March 1st to June 30th 2020 were studied. Non contrast chest CT scans, to confirm diagnosis of pneumonia, were performed. EAT volume (cm3) and attenuation (Hounsfield units) were measured using a CT post-processing software. The primary outcome was acute respiratory distress syndrome (ARDS) or in-hospital death. RESULTS: The primary outcome occurred in 56.8% patients. Fasting blood glucose was significantly higher in the group ARDS/death than in the group with better prognosis [114 (98-144) vs. 101 (91-118) mg/dl, p = 0.001]. EAT volume was higher in patients with vs without the primary outcome [103 (69.25; 129.75) vs. 78.95 (50.7; 100.25) cm3, p < 0.001] and it was positively correlated with glycemia, PCR, fibrinogen, P/F ratio. In the multivariable logistic regression analysis, age and EAT volume were independently associated with ARDS/death. Glycemia and EAT attenuation would appear to be factors involved in ARDS/death with a trend of statistical significance. CONCLUSIONS: Our findings suggest that both blood glucose and EAT, easily measurable and modifiable targets, could be important predisposing factors for severe Covid-19 complications.

Abdominal obesity phenotype predicts covid-19 chest x-ray severity score better than general obesity

Introduction: Chest x-ray (CXR) severity score and obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score is not fully explored. Methods: This retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19. Results: Patients with abdominal obesity had significantly higher CXR severity scores (Figure 1A) and higher rates of these scores than those without abdominal obesity (P<0.001;P=0.001, respectively) while there were no significant differences between BMI classes (P=0.104;P=0.271, respectively) (Figure 1B). Waist circumference and waist-to-height ratio correlated more closely with CXR severity score than BMI (r=0.43, P<0.001;r=0.41, P<0.001;r=0.17, P=0.012, respectively). The AUCs for waist circumference and WHtR were significantly higher than those for BMI for distinguishing a high CXR severity score (≥8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P=0.001) (Figure 2). Multivariable analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P<0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P=0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P<0.001) as the only independent predictors of a high CXR severity score. Conclusion: Abdominal obesity might predict a high CXR severity score better than general obesity in hospitalized patients with COVID-19. Therefore, in hospital clinical practice waist circumference should be assessed and patients with abdominal obesity should be monitored closely.