Riassunto analitico
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of coronavirus disease 2019 (COVID-19). Following its outbreak, great efforts have been made to study its pathophysiology and clinical manifestations. Although the most prevalent manifestation of COVID-19 is pneumonia, extrapulmonary events have been also observed (such as immunological, hematological, cardiovascular manifestations).
In this study we aimed to evaluate the impact of body composition assessed by thoracic CT, including measures of mass and quality of lean and fat, on COVID-19 disease progression. Secondarily the impact of anthropometric measures was also evaluated as mediators of the relationship between age and death in COVID-19.
This was an observational retrospective cohort study of patients presenting to the Reggio Emilia Arcispedale Santa Maria Nuova emergency rooms (ERs) between February 27 and March 13, 2020 for suspected COVID-19. We included positive patients on RT-PCR for SARS-CoV-2 within 10 days from ER presentation which also have undergone a thoracic CT. Hospitalization, a composite outcome of invasive mechanical ventilation (IMV) and/or death and death alone were intended as indicators of COVID-19 progression and have been compared with body composition variables defined as pectoral density, total adipose tissue (TAT), visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT). Logistic univariate models were adjusted for age, sex, and calendar time (weeks since the beginning of the outbreak) and used to evaluate the association with CT body composition parameters.
We enrolled 318 patients (37.7% females, median age 65.7 years) with a Charlson Comorbidity Index > 0 in 24.9% of cases. Diabetes and cardiovascular diseases were present in 13.5% and 7.5% of cases, respectively. Both univariate and multivariate analysis showed an association between ectopic fat and increased hospitalization and the composite outcome. The relationship between age and death is mediated by lean density.
In conclusion this study described the impact of ectopic fat and lean quality on COVID-19 progression.
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