The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

Abstract

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment

“…Although not optimal, other landmarks and isolated muscle groups have been used in clinical settings, including pectoralis muscle area, psoas muscle area or thigh muscles [11,12]. Low muscle mass is associated with clinical outcomes in COVID-19 patients; according to Besutti et al, higher pectoralis muscle crosssectional area, measured by chest CT images, showed a protective effect on hospitalization, mechanical ventilation (MV) and death [13]. Similar findings were reported by Ufuk et al using chest images for pectoralis SMI assessment in 130 patients [14].…”

Impact of Pectoral Muscle Values on Clinical Outcomes in Patients With Severe Covid-19 Disease

“…In the sample by Kim et al, the ICU admission rate was only 8.3% (35). The percentage of patients receiving mechanical ventilation were 6.6%, 11.5% (22,26,35). The study by Moctezuma-Velázquez had a patient cohort with characteristics closer to ours, with an ICU admission rate of 40% and a mortality of 25%, revealing no association with clinical outcomes (27).…”

“…Some authors have described that certain body composition parameters can identify unfavorable outcome in patients with Covid-19. For example, a higher level of adipose tissue has been associated with higher rates of hospitalization and mechanical ventilation (22)(23)(24). In another study, higher visceral fat area and higher abdominal circumference measured at the lumbar level were correlated with higher rates of transfer to the Intensive Care Unit (ICU) and mechanical ventilation, but mortality was not investigated (25).…”

Association of body composition parameters measured on CT with risk of hospitalization in patients with Covid-19

“…There has been recent work in developing deep learning based segmentation methods that also can be incorporated in such analysis [25] , [26] . In a recently published study, measure of muscle and visceral adiposity on chest CT at T7-T8 level was also associated with risk of hospitalization, mechanical ventilation and death [27] . In the future, we plan to develop a model that includes various measures of muscle adiposity and visceral adiposity on chest CT in addition to abdominopelvic CT to predict the need for hospitalization in patients that have chest CT but not abdominopelvic CT.…”