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1.
BMC Infect Dis ; 21(1): 1240, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1566511

ABSTRACT

BACKGROUND: Clarification of the risk factors for coronavirus disease 2019 (COVID-19) severity is strongly warranted for global health. Recent studies have indicated that elevated body mass index (BMI) is associated with unfavorable progression of COVID-19. This is assumed to be due to excessive deposition of visceral adipose tissue (VAT); however, the evidence investigating the association between intra-abdominal fat and COVID-19 prognosis is sparse. We therefore investigated whether measuring the amount of intra-abdominal fat is useful to predict the prognosis of COVID-19. METHODS: The present study enrolled 53 consecutive cases of COVID-19 patients aged ≥ 20 years with chest computed tomography (CT) scans. The VAT area, total adipose tissue (TAT) area, and VAT/TAT ratio were estimated using axial CT images at the level of the upper pole of the right kidney. Severe COVID-19 was defined as death or acute respiratory failure demanding oxygen at ≥ 6 L per minute, a high-flow nasal cannula, or mechanical ventilation. The association of VAT/TAT with the incidence of progression to a severe state was estimated as a hazard ratio (HR) using Cox regression analysis. To compare the prediction ability for COVID-19 disease progression between BMI and VAT/TAT, the area under the receiver operating characteristic curve (AUC) of each was assessed. RESULTS: A total of 15 cases (28.3% of the whole study subjects) progressed to severe stages. The incidence of developing severe COVID-19 increased significantly with VAT/TAT (HR per 1% increase = 1.040 (95% CI 1.008-1.074), P = 0.01). After adjustment for potential confounders, the positive association of VAT/TAT with COVID-19 aggravation remained significant (multivariable-adjusted HR = 1.055 (95% CI 1.000-1.112) per 1% increase, P = 0.049). The predictive ability of VAT/TAT for COVID-19 becoming severe was significantly better than that of BMI (AUC of 0.73 for VAT/TAT and 0.50 for BMI; P = 0.0495 for the difference). CONCLUSIONS: A higher ratio of VAT/TAT was an independent risk factor for disease progression among COVID-19 patients. VAT/TAT was superior to BMI in predicting COVID-19 morbidity. COVID-19 patients with high VAT/TAT levels should be carefully observed as high-risk individuals for morbidity and mortality.


Subject(s)
COVID-19 , Intra-Abdominal Fat , Body Mass Index , Cohort Studies , Humans , Intra-Abdominal Fat/diagnostic imaging , Prognosis , SARS-CoV-2
2.
Nutr Metab Cardiovasc Dis ; 31(7): 2156-2164, 2021 06 30.
Article in English | MEDLINE | ID: covidwho-1249046

ABSTRACT

BACKGROUND AND AIMS: Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients. METHODS AND RESULTS: This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25th to April 19th, 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25th-75th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO2/FiO2 was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO2/FiO2 identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p < 0.0001). CONCLUSION: Increased EAT attenuation, a marker of EAT inflammation, but not obesity or EAT volume, predicts critical COVID-19. TRIAL REGISTRATION: NCT04318366.


Subject(s)
Adiposity , COVID-19/diagnostic imaging , Intra-Abdominal Fat/diagnostic imaging , Obesity/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Aged , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Female , Hospital Mortality , Humans , Intra-Abdominal Fat/physiopathology , Italy , Male , Middle Aged , Obesity/mortality , Obesity/physiopathology , Pericardium , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Risk Factors
3.
Obesity (Silver Spring) ; 29(9): 1427-1433, 2021 09.
Article in English | MEDLINE | ID: covidwho-1239993

ABSTRACT

OBJECTIVE: Adipose tissue plays a role in the novel coronavirus disease 2019 (COVID-19). Epicardial adipose tissue (EAT), a unique visceral fat, presents with a high degree of inflammation in severe COVID-19. Whether and how adipose tissue may respond to the COVID-19 therapies is unknown. METHODS: The difference in computed tomography-measured EAT and subcutaneous (SAT) attenuation, defined as mean attenuation expressed in Hounsfield units (HU), was retrospectively analyzed in 72 patients (mean [SD] age was 59.6 [12.4] years, 50 patients [69%] were men) at the hospital admission for COVID-19 and 99 days (interquartile range = 71-129) after discharge. RESULTS: At the admission, EAT-HU was significantly correlated with blood glucose levels, interleukin 6, troponin T levels, and waist circumference. EAT-HU decreased from -87.21 (16.18) to -100.0 (11) (p < 0.001), whereas SAT-HU did not change (-110.21 [12.1] to -111.11 [27.82]; p = 0.78) after therapy. Changes in EAT-HU (expressed as ∆) significantly correlated with dexamethasone therapy (r = -0.46, p = 0.006) and when dexamethasone was combined with tocilizumab (r = -0.24, p = 0.04). CONCLUSIONS: Dexamethasone therapy was associated with significant reduction of EAT inflammation in COVID-19 patients, whereas SAT showed no changes. Anti-inflammatory therapies targeting visceral fat may be helpful in COVID-19.


Subject(s)
COVID-19 , Dexamethasone/therapeutic use , Intra-Abdominal Fat , Pericardium , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Female , Humans , Inflammation , Intra-Abdominal Fat/diagnostic imaging , Male , Middle Aged , Pericardium/diagnostic imaging , Retrospective Studies
4.
PLoS One ; 16(5): e0251768, 2021.
Article in English | MEDLINE | ID: covidwho-1229049

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 Outcome
5.
Metabolism ; 115: 154440, 2021 02.
Article in English | MEDLINE | ID: covidwho-1071780

ABSTRACT

BACKGROUND: Excess visceral fat (VF) or high body mass index (BMI) is risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients. AIM: To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI. METHODS: We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR. RESULTS: Among 165 patients with a mean BMI of 26.1 ±â€¯5.4 kg/m2, VF was associated with severe COVID-19 (p = 0.022) and SCF was not (p = 0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p = 0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5 cm2 (ROC curve), which was independently associated with COVID-19 severity (p < 0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r2 = 0.27 vs 0.0008). CONCLUSION: Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.


Subject(s)
COVID-19/complications , Intra-Abdominal Fat/diagnostic imaging , Obesity, Abdominal/complications , Adult , Aged , Aged, 80 and over , Angiotensin-Converting Enzyme 2/immunology , Body Mass Index , COVID-19/diagnostic imaging , COVID-19/epidemiology , Female , France , Humans , Male , Middle Aged , Obesity, Abdominal/diagnostic imaging , Obesity, Abdominal/epidemiology , Predictive Value of Tests , Prognosis , Respiration, Artificial , Risk Factors , Subcutaneous Fat/diagnostic imaging , Tomography, X-Ray Computed
6.
Metabolism ; 110: 154317, 2020 09.
Article in English | MEDLINE | ID: covidwho-935816

ABSTRACT

BACKGROUND AND AIMS: Overall obesity has recently been established as an independent risk factor for critical illness in patients with coronavirus disease 2019 (COVID-19). The role of fat distribution and especially that of visceral fat, which is often associated with metabolic syndrome, remains unclear. Therefore, this study aims at investigating the association between fat distribution and COVID-19 severity. METHODS: Thirty patients with COVID-19 and a mean age of 65.6 ±â€¯13.1 years from a level-one medical center in Berlin, Germany, were included in the present cross-sectional analysis. COVID-19 was confirmed by polymerase chain reaction (PCR) from nasal and throat swabs. A severe clinical course of COVID-19 was defined by hospitalization in the intensive care unit (ICU) and/or invasive mechanical ventilation. Fat was measured at the level of the first lumbar vertebra on routinely acquired low-dose chest computed tomography (CT). RESULTS: An increase in visceral fat area (VFA) by ten square centimeters was associated with a 1.37-fold higher likelihood of ICU treatment and a 1.32-fold higher likelihood of mechanical ventilation (adjusted for age and sex). For upper abdominal circumference, each additional centimeter of circumference was associated with a 1.13-fold higher likelihood of ICU treatment and a 1.25-fold higher likelihood of mechanical ventilation. CONCLUSIONS: Our proof-of-concept study suggests that visceral adipose tissue and upper abdominal circumference specifically increase the likelihood of COVID-19 severity. CT-based quantification of visceral adipose tissue and upper abdominal circumference in routine chest CTs may therefore be a simple tool for risk assessment in COVID-19 patients.


Subject(s)
Adiposity/physiology , Betacoronavirus , Coronavirus Infections/etiology , Intra-Abdominal Fat/physiology , Pneumonia, Viral/etiology , Aged , Aged, 80 and over , COVID-19 , Cross-Sectional Studies , Humans , Intra-Abdominal Fat/diagnostic imaging , Middle Aged , Pandemics , Pilot Projects , SARS-CoV-2 , Tomography, X-Ray Computed
7.
Metabolism ; 113: 154378, 2020 12.
Article in English | MEDLINE | ID: covidwho-799347

ABSTRACT

BACKGROUND: Obesity is common in patients with coronavirus disease 2019 (COVID-19). The effects of obesity on clinical outcomes of COVID-19 warrant systematical investigation. OBJECTIVE: This study explores the effects of obesity with the risk of severe disease among patients with COVID-19. METHODS: Body mass index (BMI) and degree of visceral adipose tissue (VAT) accumulation were used as indicators for obesity status. Publication databases including preprints were searched up to August 10, 2020. Clinical outcomes of severe COVID-19 included hospitalization, a requirement for treatment in an intensive care unit (ICU), invasive mechanical ventilation (IMV), and mortality. Risks for severe COVID-19 outcomes are presented as odds ratios (OR) and 95% confidence interval (95%CI) for cohort studies with BMI-defined obesity, and standardized mean difference (SMD) and 95%CI for controlled studies with VAT-defined excessive adiposity. RESULTS: A total of 45, 650 participants from 30 studies with BMI-defined obesity and 3 controlled studies with VAT-defined adiposity were included for assessing the risk of severe COVID-19. Univariate analyses showed significantly higher ORs of severe COVID-19 with higher BMI: 1.76 (95%: 1.21, 2.56, P = 0.003) for hospitalization, 1.67 (95%CI: 1.26, 2.21, P<0.001) for ICU admission, 2.19 (95%CI: 1.56, 3.07, P<0.001) for IMV requirement, and 1.37 (95%CI: 1.06, 1.75, P = 0.014) for death, giving an overall OR for severe COVID-19 of 1.67 (95%CI: 1.43, 1.96; P<0.001). Multivariate analyses revealed increased ORs of severe COVID-19 associated with higher BMI: 2.36 (95%CI: 1.37, 4.07, P = 0.002) for hospitalization, 2.32 (95%CI: 1.38, 3.90, P = 0.001) for requiring ICU admission, 2.63 (95%CI: 1.32, 5.25, P = 0.006) for IMV support, and 1.49 (95%CI: 1.20, 1.85, P<0.001) for mortality, giving an overall OR for severe COVID-19 of 2.09 (95%CI: 1.67, 2.62; P<0.001). Compared to non-severe COVID-19 patients, severe COVID-19 cases showed significantly higher VAT accumulation with a SMD of 0.49 for hospitalization (95% CI: 0.11, 0.87; P = 0.011), 0.57 (95% CI: 0.33, 0.81; P<0.001) for requiring ICU admission and 0.37 (95% CI: 0.03, 0.71; P = 0.035) for IMV support. The overall SMD for severe COVID-19 was 0.50 (95% CI: 0.33, 0.68; P<0.001). CONCLUSIONS: Obesity increases risk for hospitalization, ICU admission, IMV requirement and death among patients with COVID-19. Further, excessive visceral adiposity appears to be associated with severe COVID-19 outcomes. These findings emphasize the need for effective actions by individuals, the public and governments to increase awareness of the risks resulting from obesity and how these are heightened in the current global pandemic.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Obesity/epidemiology , Obesity/therapy , Body Mass Index , COVID-19/complications , COVID-19/epidemiology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Intra-Abdominal Fat/diagnostic imaging , Intra-Abdominal Fat/pathology , Intra-Abdominal Fat/physiology , Mortality , Obesity/complications , Obesity/diagnosis , Pandemics , Patient Admission/statistics & numerical data , Prognosis , Respiration, Artificial/statistics & numerical data , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , Tomography, X-Ray Computed
8.
Abdom Radiol (NY) ; 46(2): 818-825, 2021 02.
Article in English | MEDLINE | ID: covidwho-691818

ABSTRACT

PURPOSE: To assess visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) estimates at abdominopelvic CT in COVID-19 patients with different severity, and analyze Body Mass Index (BMI) and CT estimates of fat content in patients requiring hospitalization. METHODS: In this retrospective IRB approved HIPPA compliant study, 51 patients with SARS-CoV-2 infection with abdominopelvic CT were included. Patients were stratified based on disease severity as outpatient (no hospital admission) and patients who were hospitalized. Subset of hospitalized patient required mechanical ventilation (MV). A radiologist blinded to the clinical outcome evaluated single axial slice on CT at L3 vertebral body for VATL3, SATL3, TATL3, and VAT/TATL3. These measures along with age, gender, and BMI were compared. A clinical model that included age, sex, and BMI was compared to clinical + CT model that also included VATL3 to discriminate hospitalized patients from outpatients. RESULTS: There were ten outpatients and 41 hospitalized patients. 11 hospitalized patients required MV. There were no significant differences in age and BMI between the hospitalized and outpatients (all p > 0.05). There was significantly higher VATL3 and VAT/TATL3 in hospitalized patients compared to the outpatients (all p < 0.05). Area under the curve (AUC) of the clinical + CT model was higher compared to the clinical model (AUC 0.847 versus 0.750) for identifying patients requiring hospitalization. CONCLUSION: Higher VATL3 was observed in COVID-19 patients that required hospitalization compared to the outpatients, and addition of VATL3 to the clinical model improved AUC in discriminating hospitalized from outpatients in this preliminary study.


Subject(s)
COVID-19/physiopathology , Intra-Abdominal Fat/diagnostic imaging , Intra-Abdominal Fat/physiopathology , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment/methods , SARS-CoV-2 , Severity of Illness Index , Young Adult
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