ABSTRACT
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.