CT-derived Chest Muscle Metrics for Outcome Prediction in Patients with COVID-19

Abstract

Background Lower muscle mass is a known predictor of unfavorable outcome, but its prognostic impact on COVID-19 patients is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in COVID-19 patients. Materials and Methods Clinical/laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. Extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation of paravertebral muscles were measured on axial CT images at T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation odds ratios (OR) with 95% confidence intervals (CIs), were used to build four models to predict ICU admission and death, tested and compared using receiver operating characteristic curve (ROC) analysis. Results A total 552 patients (364 men; median age 65 years, interquartile range 54–75) were included. In a CT-based model, lower-than-median T5 paravertebral muscle area showed the highest ORs for ICU admission (OR 4.8, 95% CI 2.7–8.5; P <.001) and death (OR 2.3, 95% CI 1.0–2.9; P =.027). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle area still showed the highest ORs both for ICU admission (OR 4.3; 95% CI 2.5–7.7; P <.001) and death (OR 2.3, 95% CI 1.3–3.7; P =.001). At ROC analysis, the CT-based model and the model including clinical variables showed the same area under the curve (AUC) for ICU admission prediction (AUC 0.83, P =.380) and were not different in predicting death (AUC 0.86 versus AUC 0.87, respectively, P =.282). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT was independently associated with ICU admission and hospital mortality.

Nutritional parameters associated with prognosis in non-critically ill hospitalized COVID-19 patients: The NUTRI-COVID19 study

“…Nowadays, the assessment of body composition represents a cornerstone in nutritional science, due to its prognostic value in different clinical conditions [33]. Schiaffino et al observed that low muscle mass detected by CT scans was independently associated with in-hospital mortality and ICU admission among COVID-19 patients [34]. On the contrary, a retrospective study observed that bioimpedance analysis does not appear to bring further predictive value than nutritional risk screening alone [35].…”

Sarcopenia: imaging assessment and clinical application

“…Recently, sarcopenia has been also reported as an independent factor associated with intensive care unit admission and mortality in patients hospitalized for COVID-19 pneumonia (Fig. 1 ) [ 24 ]. In inflammatory bowel disease, sarcopenia has a prevalence ranging from 27 to 61% [ 25 ], and is proven to be a negative prognostic factor for intestinal resection, especially in patients with Crohn’s disease [ 26 ].…”

Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: A review

“…It is frequently possible to conduct a CT-based estimation of muscle mass since patients who are hospitalized are often imaged as a part of their diagnostic work-up. An observational study found that a decreased paraspinal muscle area at the level of the 5 th thoracic vertebra correlated with an increased risk of ICU admission and death in hospitalized adults and elderly patients (median age 65 years) with a COVID-19 infection who were scanned as a part of their routine care [123]. Another cohort study with patients whose median age was 62 years showed that those patients defined as sarcopenic on the basis of their skeletal muscle index (cross-sectional muscle area measured at the level of the 12 th thoracic vertebra) experienced a longer duration of hospital stay and were more likely to die from the infection [124].…”