Relation Between Body Composition, Systemic Inflammatory Response, and Clinical Outcomes in Patients Admitted to an Urban Teaching Hospital with COVID-19

Abstract

Background COVID-19 has been associated with cases of severe respiratory illness, admissions to intensive therapy units (ITUs), and high mortality rates. Objectives The aim of the present study was to examine the relation between computed tomography- body composition (CT-BC) measurements, systemic inflammation, and clinical outcomes in those with COVID-19. Methods Patients who presented to our institution between March 17 and May 1, 2020, with a positive PCR test for COVID-19 or characteristic radiological changes, were assessed for inclusion. Data collected included general demographic details, clinicopathological variables, poGPS, NLR , CT-BC measurements, and clinical outcomes including ITU admission and 30-d mortality, of those admitted. Results Sixty-three patients met the study inclusion criteria. Forty-two patients (67%) were aged ≥70 y, 30 (47.6%) were male and 34.9% ( n = 22) had a poGPS ≥1. ITU admission was significantly associated with a high VFA ( P < 0.05). Thirty-day mortality was associated with high VFA (P < 0.05) and low SMI (P < 0.05). Conclusions Sarcopenia in the presence of obesity was associated with clinical outcomes including greater 30-d mortality.

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

“…It is likely that in such study collective body composition parameters have less influence on the clinical outcome than other influencing factors as, e.g., bacterial superinfection, thrombosis, embolism, or bleeding. However, the negative impact of sarcopenia on the clinical outcome in the healthy older population 11 , 46 , 47 is known, and effects of obesity 7 , 8 , reduced muscle mass 10 , or muscle quality 6 on COVID-19 patients have been described. Also, while no association for the FMR to IMV or time to death was found, Kottlors et al have described its use to predict ICU admission 17 .…”

“…In COVID-19 patients, a loss of lean muscle mass over the disease period has been described 5 , and a better thoracic muscle quality has been shown to be a protective factor against hospitalization, invasive mechanical ventilation (IMV), and death 6 . Also, obesity has been found to be significantly associated with higher hospitalization rates, IMV, intensive care unit (ICU) admission, and death 7 , while visceral and muscular fat amounts were related to the probability of ICU admission 8 – 10 .…”

“…In CT scans, which severely ill patients frequently receive, body composition measurements at the height of the third lumbar vertebra (L3) best represent the whole-body fat and muscle mass 13 . CT body composition parameters at L3 have been found to be of predictive value in many entities including COVID-19 9 , 10 , 14 . However, most COVID-19 patients only receive chest X-rays or thoracic CT scans and while there are reviews with hundreds of studies on abdominal CT body composition measurements 15 , 16 experience on thoracic CT body composition parameters is less profound, with especially few studies on thoracic CT body composition assessment in COVID-19 5 , 6 , 17 .…”

The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

“…However, a recent cohort study (n = 1071) comparing the effect of frailty on 30-day mortality in COVID-19 positive and COVID-19 negative older patients (> 65 years), reported that frailty made only a small contribution to the hazard of dying in patients admitted with COVID-19 [ 8 ]. Furthermore, independent of age, comorbidity including obesity, sarcopenia and systemic inflammation are also associated with worsened clinical outcomes [ 7 , 9 ]. At present, the basis of the relationship between age, frailty and clinical outcomes is not clear.…”

Poor Nutritional Status and Dynapenia Are Highly Prevalent in Post-Acute COVID-19

“…Finally, the prevalence of malnutrition was related to the number of comorbidities only for MNA but not for CONUT (data not shown), in partial disagreement with previous studies (32,36). As for BC, while obesity and increased FM have frequently been associated with disease severity, length of hospital stay, ICU admission, and death (3,20,(37)(38)(39)(40)(41)(42)(43)(44), only a few studies have yielded data on muscle wasting, low FFM, and appendicular skeletal muscle in COVID-19 patients (4,7,8,14); for instance, a low pectoralis muscle area was found to be a predictor of poor prognosis (45). According to the data of this study, low FFMI and low SMI (by BIA) were observed in 17% and 31% of the whole sample, respectively (no previous evidence is available in the literature), being more common in malnourished patients as identified by MNA.…”