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1.
Gastroenterology ; 162(7):S-837, 2022.
Article in English | EMBASE | ID: covidwho-1967373

ABSTRACT

Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.

2.
Gastroenterology ; 162(7):S-836, 2022.
Article in English | EMBASE | ID: covidwho-1967372

ABSTRACT

Background and Aims: In patients with COVID-19, obesity may increase risk of hospitalisation, use of mechanical ventilation and patient mortality. High liver fat, body mass index (BMI) and male sex are significant predictors of hospitalisation risk following COVID-19. However, BMI is a poor indicator of body fat distribution. Here, we studied ectopic fat accumulation within the liver and pancreas and body composition through multiparametric magnetic resonance (mpMR) and compared participants with and without hospitalisation for COVID-19. Method: Participants with laboratory-confirmed or clinically suspected SARSCoV- 2 infection were recruited to the COVERSCAN study (NCT04369807;median time from initial symptoms = 177 days) and underwent a multi-organ mpMR scan (CoverScan®, Perspectum Ltd). Measures of liver and pancreatic fat (PDFF), liver fibroinflammation (cT1) and body composition [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle index (SMI)] were analysed. Differences between participants hospitalised (n = 59) and not hospitalised (n = 348) for COVID-19 were assessed using Wilcoxon signedrank tests. Univariate and multivariate analyses were performed on all biomarkers to assess the hospitalisation risk. Data presented are median values. Results: Approximately 6-months after initial symptoms, participants hospitalised following COVID-19 had significantly elevated pancreatic fat (3.8 % vs 2.8 %, p < 0.01), liver fat (3.8 % vs 2.4 %, p < 0.01) and liver cT1 (735ms vs 706ms, p < 0.01) compared to those who convalesced at home. Though hospitalised participants had a significantly elevated BMI (27 kg/m2 vs 25 kg/m2, p = 0.014), it was VAT, but not SAT, that was significantly elevated (132 cm2 vs 86 cm2, p < 0.01). Univariate analysis revealed that male sex, advanced age and elevated BMI, VAT, pancreatic fat, liver fat, and liver cT1 were all significantly predictive of hospitalisation following COVID- 19. In multivariate analysis, only age remained significantly predictive of hospitalisation. In hospitalised people with obesity (³ 30 kg/m2), VAT, liver cT1 and liver fat, but not BMI nor pancreatic fat, remained significantly elevated [VAT: 220 cm2 vs 152cm2, p = 0.01 (Figure 1);liver fat: 9.9 % vs 4.2 %, p = 0.003;liver cT1: 782ms vs 742ms, p = 0.012]. Conclusion: mpMR revealed significantly elevated visceral and ectopic fat deposition within the liver and pancreas in hospitalised participants following COVID-19. In obese participants, BMI was not significantly different in hospitalised, and non-hospitalised patients, whereas visceral fat, liver fibroinflammation and liver fat were significantly elevated. Our work highlights body fat distribution an important consideration for COVID-19 risk profiling, which cannot be sufficiently evaluated based on BMI alone. (Figure Presented) Figure 1. Comparison of liver fat (left), pancreatic fat (middle) and visceral adipose tissue (right) between participants hospitalised and not hospitalised following COVID-19.

3.
Journal of the American College of Cardiology ; 79(9):1312-1312, 2022.
Article in English | Web of Science | ID: covidwho-1849195
4.
Hepatology ; 74(SUPPL 1):317A, 2021.
Article in English | EMBASE | ID: covidwho-1508765

ABSTRACT

Background: In patients infected with the SARS-CoV-2 (COVID-19) virus, obesity is associated with an increase in hospital admission, use of mechanical ventilation and patient mortality. Elevated liver fat, body mass index (BMI) and male sex are significant predictors of hospitalisation risk following COVID-19. BMI, however, is a poor indicator of body fat distribution. Here, we aim to characterise body composition and liver health through multiparametric magnetic resonance (mpMR) and compare participants hospitalised and not hospitalised following COVID-19. Methods: Participants with laboratory confirmed or clinically suspected SARSCoV-2 infection were recruited to the COVERSCAN study (NCT04369807) and underwent a multi-organ mpMR scan (median time from initial symptom = 177 days). Measures of liver fat (PDFF), liver fibroinflammation (cT1) and body composition (VAT, subcutaneous adipose tissue [SAT], skeletal muscle index [SMI]) were analysed. Differences between hospitalised (n=60) and non-hospitalised participants (n=354) were assessed using Wilcoxon signed-rank tests. Univariate and multivariate analysis were performed on all biomarkers to assess the risk of hospitalisation. Presented data are median values. Results: Hospitalised participants were older (50yrs vs 43yrs;p<0.01) and had significantly elevated liver fat (3.5% vs 2.4%;p<0.01) and liver cT1 (734ms vs 708ms;p<0.01). Though hospitalised participants had a significantly elevated BMI (27kg/m2 vs 25kg/m2;p=0.011), it was VAT, but not SAT or SMI, that was significantly elevated in hospitalised participants (131cm2 vs 80 cm2;p<0.01). Univariate analysis revealed male sex, advanced age and elevated BMI, VAT, liver fat and liver cT1 were all significantly predictive of hospitalisation. In multivariate analysis, only age remained significantly predictive of hospitalisation. In obese participants, VAT and liver fat, but not BMI nor cT1, remained significantly elevated in hospitalised participants (VAT: 200cm2 vs 159cm2, p=0.041;liver fat: 9.8% vs 4.6%, p=0.012). Conclusion: mpMR revealed significantly elevated visceral and ectopic liver fat in hospitalised participants following COVID-19 infection. In obese participants, BMI was not significantly different in hospitalised and non-hospitalised patients whereas visceral and liver fat remained significantly elevated. Our work highlights body fat distribution as an important consideration for COVID-19 risk profiling which is not sufficiently evaluated based on BMI alone.

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