The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients.

Giulia Besutti,Carlo Salvarani,Michele Cantini,Paolo Giorgi Rossi,Marta Ottone,Pierpaolo Pattacini,Lucia Spaggiari,Efrem Bonelli,Guido Ligabue,Tommaso Fasano,Giulia Cassone,Giovanni Guaraldi,Massimo Pellegrini,Simone Canovi,Jovana Milic,Marco Massari,Giovanni Dolci,On Behalf Of The Reggio Emilia Covid-19 Working Group

doi:10.1371/journal.pone.0251768

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.

Highlights

A novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has recently emerged as a global health threat [1, 2]
Through a mediation analysis of the factors associated with age and death, secondly, we evaluated whether the effect of age on death is partly mediated by body composition
Association of CT fat distribution parameters with body mass index (BMI) was estimated only for patients with an available BMI measured within six months previous to emergency rooms (ERs) presentation (n = 88)

Summary

Introduction

A novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has recently emerged as a global health threat [1, 2]. Most severe COVID-19 patients develop acute respiratory distress syndrome (ARDS) or sepsis with multiorgan dysfunction [1, 4, 5], often associated with an uncontrolled cytokine-mediated immune response called the cytokine storm. Of these patients, 71–75% need assisted mechanical ventilation and about 50% die [1, 2, 5,6,7]. Obesity and advanced age are among the most important recognized risk factors for an unfavorable outcome in COVID19 patients [1, 2, 8,9,10]

Results

Discussion

Conclusion