Analysis of Risk Factors of Soft Tissue Bleeding in COVID-19 Patients: A Point of View After Two Years of Pandemic

Abstract

Background:The aim of the study was to analyze the relationship between patient characteristics, including anagraphic and laboratoristic data and amount of adipose tissue measured in computed tomography (CT) scans in coronavirus disease 2019 (COVID-19) patients, and incidence of soft tissue bleeding requiring medical and/or interventional radiology management.Methods: A total of 132 patients hospitalized for COVID-19 pathology from October 2020 to May 2021 were included in the study and divided into two groups: a bleeding group of 70 cases with soft tissue bleeding occurring during hospitalization, and a control group of 62 hospitalized COVID-19 patients without bleeding events. In the bleeding group, two subgroups were considered: an embolization group including soft tissue bleeding cases requiring interventional radiology with transarterial embolization (TAE) (16/70; 22.9%) and a non-embolization group, clinically managed without TAE (54/70; 77.1%). Demographics and clinical data, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area measured on CT images and VAT/SAT ratio were compared between bleeding and control groups and between embolization and non-embolization subgroups.Results: Bleeding and control groups did not significantly differ for sex distribution, COVID-19, platelet (PLT) count, international normalized ratio (INR), SAT area, VAT area, and VAT/SAT ratio. Embolization and non-embolization groups did not significantly differ for age, COVID-19, PLT count, INR, SAT area, and VAT/SAT ratio.Bleeding group had lower body mass index (BMI) than control group as well as embolization group compared to non-embolization group. A statistically significant difference was observed between embolization and non-embolization groups for VAT area, with smaller values in embolization group (mean difference: 64.2 cm 2 , 95% confidence interval: 8.3 -120.1; P < 0.05). Conclusion:Soft tissue bleeding in COVID-19 is more frequent and severe in patients with low amount of VAT, demonstrating that fat mass may have a containing function on bleeding, limiting its progression in surrounding structures. There are some other factors that influence the risk of bleeding, such as age, thromboprophylaxis therapy and BMI.

Assessment of body composition in adults hospitalized with acute COVID-19: a scoping review

“…Out of the studies with US, one evaluated the treatment and prevention of sarcopenia by arginine supplementation ( 29 ). CT on the other hand was used in five studies with different objectives, e.g., assessing nutritional status and outcomes in patients after ICU discharge ( 46 ), examining the relationship between patients admitted with COVID-19 and frailty and other prognostic factors ( 64 ), investigating obesity or sarcopenia through the T12 and L3 scans ( 66 ), and assessing tissue bleeding and BC parameters ( 63 ). Finally, Gualtieri, evaluated the differences in BC of aldults with obesity and without obesity during ICU stay ( 36 ).…”

“…Regarding the sex of the participants, the most prevalent was male in most of the studies, with frequencies varying from 53.3% ( 41 ) to 93.3% ( 28 ). A few studies had smaller percentages of males in the sample, the studies of Kremer et al that had 50% of males ( 32 ), McGovern et al with 47.3% ( 47 ), Yang et al with 46.9% ( 40 ), and Faiella et al ( 63 ) with 50% and 46% in the bleeding group and control group, respectively.…”

“…CT stood out as the most frequently used method to describe BC, with 36 studies ( 7 , 15 , 16 , 34 – 37 , 39 – 66 ). VAT was evaluated in 21 studies ( 15 , 16 , 34 – 36 , 39 – 42 , 45 , 47 , 49 – 51 , 53 , 55 , 60 , 63 , 64 , 66 ). MM was evaluated in another 24 studies through muscle quantity ( 7 , 16 , 36 , 37 , 40 , 42 – 44 , 48 , 49 , 52 , 53 , 56 – 62 , 65 , 66 ), SMD ( 36 , 41 , 44 , 46 , 47 , 52 , 54 , 57 , 58 , 61 , 66 ), or index ( 47 , 49 , 43 ).…”

“…Regarding the studies with CT, the radiologic tool was routinely applied in all COVID-19 patients included in the studies to check pulmonary states. Chest scans often contain the 12th thoracic vertebrae, widely reported in the included studies as the reference scan to assess BC ( 7 , 36 , 37 , 48 , 53 , 56 , 57 , 59 , 60 , 65 , 66 ) and the third lumbar vertebrae as well ( 15 , 16 , 35 , 40 , 43 , 47 , 49 , 51 , 54 , 56 , 63 , 64 , 66 ). The remaining studies also utilized scans but from alternative levels ( 34 , 38 , 39 , 41 , 42 , 45 , 46 , 52 , 55 , 58 , 61 , 62 ).…”

“…Most studies aimed to investigate the associations between the prognosis of COVID-19 and the parameters derived from the tools. However, the studies using BIA by Moonen et al ( 9 ), Reyes-Torres et al ( 26 ), and Ryrsø et al ( 27 ), the studies using US by Andrade-Júnior et al ( 28 ) and Bologna and Pone ( 29 ), and the studies using CT by Hoyois et al ( 46 ), Faiella et al ( 63 ), McGovern et al ( 64 ), and Molwitz et al ( 66 ) all had other objectives but reported data on at least one BC parameter.…”