Prognostic factors of worse outcome for hospitalized COVID-19 patients, with emphasis on chest computed tomography data: a retrospective study

Abstract

Objective: To evaluate anthropometric and clinical data, muscle mass, subcutaneous fat, spine bone mineral density, extent of acute pulmonary disease related to COVID-19, quantification of pulmonary emphysema, coronary calcium, and hepatic steatosis using chest computed tomography of hospitalized patients with confirmed diagnosis of COVID-19 pneumonia and verify its association with disease severity. Methods: A total of 123 adults hospitalized due to COVID-19 pneumonia were enrolled in the present study, which evaluated the anthropometric, clinical and chest computed tomography data (pectoral and paravertebral muscle area and density, subcutaneous fat, thoracic vertebral bodies density, degree of pulmonary involvement by disease, coronary calcium quantification, liver attenuation measurement) and their association with poorer prognosis characterized through a combined outcome of intubation and mechanical ventilation, need of intensive care unit, and death. Results: Age (p=0.013), body mass index (p=0.009), lymphopenia (p=0.034), and degree of pulmonary involvement of COVID-19 pneumonia (p<0.001) were associated with poor prognosis. Extent of pulmonary involvement by COVID-19 pneumonia had an odds ratio of 1,329 for a poor prognosis and a cutoff value of 6.5 for increased risk, with a sensitivity of 64.9% and specificity of 67.1%. Conclusion: The present study found an association of high body mass index, older age, extent of pulmonary involvement by COVID-19, and lymphopenia with severity of COVID-19 pneumonia in hospitalized patients.

Prevalence and clinical implications of abnormal body composition phenotypes in patients with COVID-19: a systematic review

“…Using BIA, FFM ( 39 ) and ALST ( 38 ) were unrelated to severe COVID-19 in 2 studies. Lower muscle radiodensity was related to a greater likelihood of severe illness, including need for MV and/or greater disease severity in 5 studies ( 51 , 62 , 63 , 87 , 88 ), and unrelated/mixed findings were found in 6 studies ( 4 , 58 , 60 , 81 , 83 , 98 ). In addition, one study showed that increased muscle radiodensity was protective against MV or death (as a composite score) ( 74 ).…”

“…Seven studies found a positive association between these clinical outcomes and VAT ( 20 , 47 , 74 , 85 , 92 , 94 ), IMAT ( 62 , 74 ), SAT ( 85 ) and TAT ( 74 , 85 , 94 ). Conflicting findings were reported between adipose tissue (VAT, TAT, SAT and IMAT) and COVID-19 severity ( 6 , 20 , 58 , 62 , 92 , 96 , 98 ). Fat mass by BIA was positively related to COVID-19 severity ( 38 , 39 ) but inversely with complications ( 93 ).…”

“…Thirty-seven studies investigated the relationship between body composition abnormalities and MV or severe COVID-19 ( 4 , 6 , 20 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 50 , 51 , 54 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 74 , 78 , 81 , 82 , 83 , 85 , 87 , 88 , 89 , 92 , 93 , 94 , 96 , 97 , 98 ) ( Figure 3 , Supplementary Table 4 ). Twenty-one of these studies assessed muscle mass using CT ( 4 , 40 , 41 , 43 , 47 , 50 , 51 , 54 , 57 , 58 , 61 , 62 , 63 , 64 , 78 , 81 , 83 , 87 , 88 , 97 , 98 ) and 2 by US ( 42 , 44 ). Low muscle mass by CT was inversely related to greater disease severity and/or need for intubation in 6 studies ( 47 , 50...…”

“…Twenty-one of these studies assessed muscle mass using CT ( 4 , 40 , 41 , 43 , 47 , 50 , 51 , 54 , 57 , 58 , 61 , 62 , 63 , 64 , 78 , 81 , 83 , 87 , 88 , 97 , 98 ) and 2 by US ( 42 , 44 ). Low muscle mass by CT was inversely related to greater disease severity and/or need for intubation in 6 studies ( 47 , 50 , 61 , 63 , 64 , 88 ) and unrelated/mixed findings were found in 15 studies ( 4 , 40 , 41 , 43 , 51 , 54 , 57 , 58 , 62 , 78 , 81 , 83 , 87 , 97 , 98 ). Ultrasound muscle measurements showed conflicting or no relationships with these same outcomes ( 42 , 44 ).…”

“…The relationships between adiposity measures and MV or disease severity was evaluated in 14 studies ( 6 , 20 , 38 , 39 , 47 , 58 , 62 , 74 , 85 , 92 , 93 , 94 , 96 , 98 ). Seven studies found a positive association between these clinical outcomes and VAT ( 20 , 47 , 74 , 85 , 92 , 94 ), IMAT ( 62 , 74 ), SAT ( 85 ) and TAT ( 74 , 85 , 94 ).…”