Background: Excess visceral fat (VF) or high body mass index (BMI) is risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients. Aim: To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI. Methods: We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR. Results: Among 165 patients with a mean BMI of 26.1 ± 5.4 kg/m 2 , VF was associated with severe COVID-19 (p = 0.022) and SCF was not (p = 0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p = 0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5 cm 2 (ROC curve), which was independently associated with COVID-19 severity (p < 0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r 2 = 0.27 vs 0.0008). Conclusion: Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.

Introduction: Lors de la première vague épidémique Covid-19, des mesures de triage, sans PCR systématique, étaient mises en place pour sélectionner les patients à opérer. Notre étude a comparé leurs résultats chirurgicaux après triage à ceux d’un groupe contrôle. Matériel: L’analyse portait sur l’ensemble des patients initialement programmés dans un centre Covid de référence et inclus consécutivement, du 15 mars au 1er mai 2020 (NCT04352699). Leurs données étaient recueillies prospectivement et ultérieurement comparées à celles des patients opérés 1 an auparavant sur la même période dans ce centre. Le critère d'évaluation principal était l’admission post-opératoire en unité de soins intensifs (USI). La morbidité, la mortalité postopératoire, le report d’interventions, les tests PCR étaient évalués. Des analyses de sous-groupes étaient réalisés pour les patients opérés de cancer. Résultats: Après triage, 96 des 142 interventions programmées ont dû être reportées. Sur les opérés, 48 (68%) l’étaient pour cancer. Au total, aucun cas de pneumonie Covid-19 post-opératoire n’a été identifié. Trois patients (4 %) ont été admis en USI, dont un finalement décédé pour sepsis urinaire. Chez ces patients, les RT-PCR étaient négatives. Globalement, comparativement au groupe contrôle, aucune différence d’admission en USI, ni de taux de mortalité post-opératoire n’ont été rapportées. Conclusions: Le triage de la première vague n’a pas surexposé les patients sélectionnés à un risque de complication ou de décès post-opératoire, particulièrement pas pour ceux opérés pour cancer. En revanche, 67% des patients ont été reportés, avec un risque associé à des retard de soins pouvant conduire au décès.

INTRODUCTION AND OBJECTIVE: To assess clinical characteristics and surgical outcomes of triaged patients undergoing oncological and non-oncological surgery during the first wave of Covid-19 crisis.METHODS: We conducted a cohort-controled, nonrandomized, study in a Covid-19 reference centre in south-eastern France. Participants were consecutive surgical patients after triage and application to prevent from Covid-19 (Tab1). Data were collected prospectively during the propagation period from March 15 th to May1 st and compared with control data from outside the Covid-19 period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications were assessed. Cancer and non-cancer subgroups during Covid-19 were also compared.RESULTS: After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 yo [56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75], sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery (Tab 2). No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid-era patients (Tab 3).CONCLUSIONS: Surgery after triage during the Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be lifethreatening. Altogether, two-thirds of elective surgeries were postponed and now need to be rescheduled, thus increasing the work-load in our centre.

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