Visceral to subcutaneous fat ratio predicts short-term mortality in patients with Covid 19. A multicenter study.

OBJECTIVE: To evaluate the association of body composition parameters with outcomes in Covid-19. METHODS: 173 patients hospitalized for Covid-19 infection in 6 European centers were included in this retrospective study. Measurements were performed at L3-level and comprised skeletal muscle index (SMI), muscle density (MD), and adipose tissue measurements [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), visceral-to-subcutaneous-adipose-tissue-area-ratio (VSR)]. The association with mortality, the need for intubation (MV), and the need for admission to ICU within 30 days were evaluated. RESULTS: Higher SAT density was associated with a greater risk of MV (OR = 1.071, 95%CI=(1.034;1.110), p < 0.001). Higher VAT density was associated with admission to ICU (OR = 1.068, 95%CI=(1.029;1.109), p < 0.001). Higher MD was a protective factor for MV and ICU admission (OR = 0.914, 95%CI=(0.870;0.960), p < 0.001; OR = 0.882, 95%CI=(0.832;0.934), p = 0.028). Higher VSR was associated with mortality (OR = 2.147, 95%CI=(1.022;4.512), p = 0.044). Male sex showed the strongest influence on the risk of ICU admission and MV. SMI was not associated with either parameter. CONCLUSION: In patients hospitalized for Covid-19 infection, higher VSR seems to be a strong prognostic factor of short-term mortality. Weak associations with clinical course were found for MD and adipose tissue measurements. Male sex was the strongest prognostic factor of adverse clinical course. ADVANCES IN KNOWLEDGE: VSR is a prognostic biomarker for 30-day mortality in patients hospitalized for Covid-19 disease.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study.

RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Yoğun Bakımda Takip Edilen COVID-19 Pnömonisi Hastalarinda Akciğer Ultrason Skoru ve Mortalite Ílişkisi

Amaç: Akciğer ultrasonografisi (AUS) yatak başı yapılabilen, non-invaziv, kolayca tekrarlanabilir, radyasyon maruziyetinin olmadığı bir teknik olarak, hasta yönetiminde giderek artan şekilde kullanılmaktadır. Bu çalışmanın amacı, toraks üzerinde farklı alanlar değerlendirilerek elde edilen AUS skoru ile yoğun bakımda takip edilen COVID-19 pnömonili hastaların mortalite ilişkisinin araştırılması ve prognostik değerinin gösterilmesidir. Gereç ve Yöntem: Çalışmamızda Ístanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi’nde yoğun bakım yatış onamları alınan ve 18 yaş üzeri, COVID-19 tanısı solunum yolu örneklemesinde PCR testi ile doğrulanmış, pnömoni nedeniyle takip edilen hastalardan, yoğun bakım takibi ihtiyacı gelişen 50 hastanın, ünitemize kabul edildikten sonraki 24 saat içinde transtorasik AUS skorları hesaplanmıştır. Hastaların AUS skorları ile demografik verileri, APACHE II skorları, ferritin, D-dimer, CRP, WBC, arter kan gazı değerleri, ventilasyon durumları ve 28 günlük mortalite durumları arasındaki ilişki istatistiksel anlamlılık açısından değerlendirilmiştir. Bulgular: Çalışmaya katılan 50 hastada mortalite oranı %62 (n=31) olarak görülmüştür. Kaybedilen olguların AUS skoru, sağ kalan olgulara göre istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır (p<0,05). Mortalite ile AUS skorunun 30 kesme değeri arasında istatistiksel olarak anlamlı ilişki saptanmıştır (p<0,01). Kaybedilen olgularda AUS skorunun 30 ve üzerinde görülme riski 22,222 kat fazla bulunmuştur. Çalışmaya katılan olguların AUS skoru ile PaO2 /FiO2 oranları, APACHE II skoru ve SOFA skoru arasında pozitif yönlü ilişki istatistiksel olarak anlamlı bulunmuştur. Çalışmaya katılan olguların AUS skoru ile pH, pCO2, HCO3, laktat, CRP, ferritin, WBC, D-dimer, albumin, LDH ve prokalsitonin ölçümleri arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (p>0,05). Sonuç: COVID-19 pnömonisi ile yoğun bakımda takip edilen hastaları AUS skoru ile değerlendirdiğimiz bu çalışmada, kaybedilen olguların AUS skoru sağ kalanlara göre istatistiksel olarak anlamlı düzeyde yüksek, APACHE II, SOFA ve PaO2 /FiO2 oranları ile skor arasındaki ilişki de istatistiksel olarak anlamlı bulunmuştur. Bu bulgular ile AUS skorunun yoğun bakımdaki COVID-19 hastalarının prognozunu öngörmede başarılı olduğu, AUS’nun hasta yönetiminde ve akciğer tutulumun derecesinin belirlemesi hakkında klinisyene değerli bilgiler verdiği kanaatine varılmıştır. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

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

BACKGROUND/AIM: The effect of sarcopenia on patients with severe Covid-19 disease is unknown. We aimed to assess the influence of baseline computed tomography (CT)-based body composition parameters (pectoralis muscle area, pectoralis muscle index, skeletal muscle gauge) on clinical variables in patients with severe Covid-19 disease. PATIENTS AND METHODS: Chest CT scans of adult patients with confirmed Covid-19 who were hospitalized from March 2020 to May 2021 at a level-one medical center in Germany were retrospectively analyzed. Pectoralis muscle area, pectoralis muscle index and skeletal muscle gauge were measured on the first CT scan after admission. Body composition parameters were assessed for association with clinical variables and 30-day mortality. RESULTS: A total of 46 patients were included. None of the body composition parameters was a predictor for 30-day mortality, duration of hospital stay, duration of intensive care unit treatment, or duration of invasive mechanical ventilation. CONCLUSION: Pectoralis muscle composition parameters in CT chest scans did not predict outcomes in adult patients with severe Covid-19 infection.