ABSTRACT
We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.
Subject(s)
Body Composition , COVID-19/diagnostic imaging , COVID-19/mortality , Intra-Abdominal Fat/diagnostic imaging , Mass Chest X-Ray/methods , SARS-CoV-2/genetics , Tomography, X-Ray Computed/methods , Aged , Aged, 80 and over , Body Mass Index , COVID-19/epidemiology , COVID-19/virology , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Respiration, Artificial , Retrospective Studies , Risk Factors , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/virology , Pneumonia, Viral/virology , Virus Shedding , Adult , Age Factors , Aged , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Hospitalization , Humans , Italy , Logistic Models , Male , Middle Aged , Nasopharynx/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Prospective Studies , SARS-CoV-2 , Severity of Illness Index , Specimen Handling , Time FactorsABSTRACT
A high incidence of thrombotic events has been reported in patients with coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We report 3 clinical cases of patients in Italy with COVID-19 who developed abdominal viscera infarction, demonstrated by computed tomography.