Prediction of abdominal CT body composition parameters by thoracic measurements as a new approach to detect sarcopenia in a COVID-19 cohort

Abstract

As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02–1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92–3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45–0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study

“…Kim et al reports that LSMM is associated with prolonged hospital stay in patients with COVID-19 but not with mortality ( 22 ). However, other authors do not report significant relationships between LSMM and relevant outcomes in patients with COVID-19 ( 24 , 25 ). For example, according to Moctezuma-Velázquez et al, skeletal muscle index is not associated with negative outcomes, such as in-hospital mortality, need of invasive mechanical ventilation, and intensive care unit admission, in hospitalized patients with COVID-19 ( 24 ).…”

“…In COVID-19, data concerning the role of LSMM are mixed ( 9 , 22 , 23 , 24 , 25 ). So far, Schiaffino et al al.…”

Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…The 21 included studies comprised of 5,407 patients with COVID-19 with the mean age ranging from 44.5 to 86.1 years. Most studies (14/21) included individuals from Europe [2 from Spain ( 41 , 44 ), 4 from Italy ( 25 , 30 , 50 , 51 ), 2 from France ( 43 , 49 ), 3 from the United Kingdom ( 27 , 48 , 53 ), 1 from Germany ( 52 ), and 1 from Netherlands ( 45 )], and the rest of included studies (7/21) included individuals from Asia [3 from China ( 31 , 33 , 46 ), 2 from Turkey ( 26 , 32 ), and 1 from South Korea ( 42 )] and North America [2 from Mexico ( 29 , 47 )]. Only three included studies had a cross-sectional design ( 32 , 44 , 50 ), and the remaining eighteen studies were observational cohort studies ( 25 – 27 , 29 – 31 , 33 , 41 – 43 , 45 – 49 , 51 – 53 ).…”

“…Only three included studies had a cross-sectional design ( 32 , 44 , 50 ), and the remaining eighteen studies were observational cohort studies ( 25 – 27 , 29 – 31 , 33 , 41 – 43 , 45 – 49 , 51 – 53 ). A total of eleven included studies ( n = 1,603 patients with COVID-19) described the specific sarcopenia events between male and female patients with COVID-19 ( 26 , 29 – 31 , 42 , 43 , 47 , 49 – 52 ). Regarding the target population, most studies (20/21) recruited hospitalized patients (18 of 20 studies provided available information about patients’ hospitalization status), and the remaining one study recruited general population.…”

“…For sarcopenia assessment methods, five studies (26,30,33,42,47) (32,50) and BIA (48,51), which were used by two studies each and yielded a pooled prevalence of 26.7 (95% CI: 23.2 to 30.5%, k = 2, I 2 = 98.90%, p = 0.000) and 0.4% (95% CI: 0.1 to 0.8%, k = 2, I 2 = 97.70%, p = 0.000), respectively. For parameters used to measure sarcopenia, seven studies used skeletal muscle index (SMI) with a pooled prevalence of 49.0% (95% CI: 31.3 to 66.9%, k = 7, I 2 = 97.03%, p = 0.000) (25,29,33,42,47,52,53), 4 studies used SARF-score with a prevalence of 73% (95% CI: 49.3 to 91.3%, k = 4, I 2 = 98.00%, p = 0.000) (31,41,44,45), and two studies used HGS with a prevalence of 26.7% (95% CI: 23.2 to 30.5%, k = 2, I 2 = 98.90%, p = 0.000) (32,50). The subgroup meta-analysis result of parameters used in the remaining studies is shown in Table 3 and Supplementary Figure 6.…”