THE RELATIONSHIP BETWEEN ADIPOSITY/SARCOPENIA AND DEATH AMONG PATIENTS WITH COVID-19 DIFFERS BASED ON THE PRESENCE OF GASTROINTESTINAL SYMPTOMS

ABSTRACT

Background: Patients with SARS-CoV-2 who initially present with gastrointestinal (GI) symp-toms, with or without respiratory symptoms, have a milder clinical course than those who do not have GI complaints. Risk factors for severe COVID-19 disease include increased adiposity and sarcopenia, but whether these risk factors are similarly associated with worse outcomes among patients with GI symptoms has not been established. Methods: This was a retrospective study of hospitalized patients with COVID-19 who underwent abdominal CT scan for clinical indications within 30 days of positive SARS-COV-2 test. Abdominal body composition measures including skeletal muscle index (SMI), intramuscular adipose tissue index (IMATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral-to-subcutaneous adipose tissue ratio (VAT/SAT Ratio) were measured on a single axial CT slice at the L3 vertebral level. Hepatic steatosis was measured by absolute liver attenuation and by liver/spleen attenuation ratio. Clinical characteristics and outcomes were collected from the electronic medical record. GI symptoms were classified at time of first positive SARS-CoV-2 test. The association between body composition measurements and the primary outcome of death or discharge to hospice within 30 days after positive SARS-CoV-2 test was tested. Results: Of 190 patients with COVID-19 who had abdominal CT scans, 117 (62%) had GI symptoms including nausea, vomiting, diarrhea, or abdominal pain. Among those without GI symptoms at presentation, the most common reasons for abdominal CT scan were as part of a multi-organ evaluation of fever/sepsis, evaluation of GI symptoms that developed later during the hospital course, and evaluation for retroperitoneal hemorrhage. There were no differences in baseline patient characteristics comparing those with or without GI symptoms (Table 1). Patients with GI symptoms were less likely to be admitted to the ICU than patients without GI symptoms (16% versus 37% respectively;p <0.01) but had similar 30-day mortality (15% versus 18% respectively;p=0.66). Among patients with GI symptoms, those who died or were discharged to hospice had significantly increased IMATI (unadjusted p=0.025) and no differences in other measures (Table 2). On the other hand, among patients without GI symptoms, those who died or were discharged to hospice within 30 days had increased IMATI (p=0.049), reduced SMI (p=0.010), and increased VAT/SAT Ratio that was not statistically significant (p=0.419). Conclusions: Among patients with COVID-19, the relationship between measures of adiposity/sarcopenia and death differs in patients with and without GI symptoms.(Table Presented)Table 1. Clinical Characteristics among 190 patients hospitalized for COVID-19 based on presence of GI symptoms.(Table Presented)Table 2. Body composition measurements among 117 patients with GI symptoms and 73 patients with no GI symptoms based on death/hospice at 30 days.