Visceral adipose tissue in patients with COVID-19: risk stratification for severity

Abstract

Purpose To assess visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) estimates at abdominopelvic CT in COVID-19 patients with different severity, and analyze Body Mass Index (BMI) and CT estimates of fat content in patients requiring hospitalization. Methods In this retrospective IRB approved HIPPA compliant study, 51 patients with SARS-CoV-2 infection with abdominopelvic CT were included. Patients were stratified based on disease severity as outpatient (no hospital admission) and patients who were hospitalized. Subset of hospitalized patient required mechanical ventilation (MV). A radiologist blinded to the clinical outcome evaluated single axial slice on CT at L3 vertebral body for VAT L3 , SAT L3 , TAT L3 , and VAT/TAT L3. These measures along with age, gender, and BMI were compared. A clinical model that included age, sex, and BMI was compared to clinical + CT model that also included VAT L3 to discriminate hospitalized patients from outpatients. Results There were ten outpatients and 41 hospitalized patients. 11 hospitalized patients required MV. There were no significant differences in age and BMI between the hospitalized and outpatients (all p > 0.05). There was significantly higher VAT L3 and VAT/TAT L3 in hospitalized patients compared to the outpatients (all p < 0.05). Area under the curve (AUC) of the clinical + CT model was higher compared to the clinical model (AUC 0.847 versus 0.750) for identifying patients requiring hospitalization. Conclusion Higher VAT L3 was observed in COVID-19 patients that required hospitalization compared to the outpatients, and addition of VAT L3 to the clinical model improved AUC in discriminating hospitalized from outpatients in this preliminary study.

Visceral Adiposity Elevates the Risk of Critical Condition in COVID‐19: A Systematic Review and Meta‐Analysis

“…Yang et al did not identify SFA > 100 mm 2 as a risk factor for ICU admission (OR = 1.06, 95% CI: 0.52‐2.17) (32). However, a high VFA/SFA ratio was found to be associated with an increased risk for ICU admission (OR = 2.47, 95% CI = 1.05‐5.98) (9).…”

“…A recent meta‐analysis by Huang et al has come to the same conclusion (20); they have found higher VAT values in patients with critical condition, as well. However, their search interval was shorter, and we included two additional studies in the meta‐analyses (9,11). They did not change the direction of the results but rather confirmed the previous findings.…”

“…Although BMI is widely used to diagnose obesity (7), body composition, and especially visceral adiposity, might be an even more accurate measure to stratify patients (8‐12). Therefore, we aimed to evaluate the association between the distributions of computed tomography (CT)‐quantified fat mass and critical condition of patients with COVID‐19.…”

Impact of body composition on COVID-19 susceptibility and severity: a two-sample multivariable Mendelian randomization study

“…So far, studies investigating the role of body fat distribution on the severity and susceptibility of COVID-19 are scarce. Few observational studies investigated the association between visceral fat and COVID-19 disease severity and complications and suggested that abdominal fat is related to disease severity 29-33 . For example, in their proof-of-concept study including 30 patients with COVID-19 Petersen et al suggested that visceral fat and upper abdominal circumference specifically increased the likelihood of severe COVID-19 31 .…”

Reply to a Letter to the Editor “Is there an exposure–effect relationship between body mass index and invasive mechanical ventilation, severity, and death in patients with COVID‐19? Evidence from an updated meta‐analysis”

“…[7][8][9] Although BMI is widely used to diagnose obesity, 10 further phenotyping of patients with high BMI might improve risk stratification and help to reveal the underlying pathophysiology. [11][12][13][14][15][16] In summary, we are grateful to Liu et al…”