The predictive value of epicardial fat volume for clinical severity of COVID-19.

Introduction: Epicardial adipose tissue serves as a source of inflammatory cytokines and mediators. Cytokine storm is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19). Objectives: To investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19. Methods: This retrospective study included 101 patients who were infected with COVID-19. Serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomography images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to the intensive care unit (ICU) or death. Results: The primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died. EFV, CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation was determined between EFV and CRP (r: 0.494, p<0.001), PCT (r: 0.287, p=0.005), ferritin (r: 0.265, p=0.01) and IL-6 (r: 0.311, p=0.005). On receiver operating characteristic analysis, patients with EFV >102 cm3 were more likely to have severe complications. In multivariate logistic regression analysis, EFV independently predicted admission to the ICU at a significant level (OR: 1.02, 95% CI: 1.01-1.03, p=0.025). Conclusion: EFV and serum CRP, IL-6, PCT and ferritin levels can effectively assess disease severity and predict the outcome in patients with COVID-19. EFV is an independent predictor of admission to the ICU in hospitalized COVID-19 patients.

Introdução: O tecido adiposo epicárdico é fonte de citocinas inflamatórias e mediadores. A tempestade de citocinas é uma importante causa de morbilidade e mortalidade na doença coronavírus 2019 (COVID-19). Objetivos: Investigar a associação entre volume adiposo epicárdico (VAE), biomarcadores inflamatórios e gravidade clínica da COVID-19. Métodos: Este estudo retrospetivo incluiu 101 doentes infetados com COVID-19. Foram avaliados biomarcadores inflamatórios séricos, incluindo os níveis de proteína C-reativa (PCR), de interleucina-6 (IL-6), de procalcitonina (PCT) e de ferritina. Foram analisadas imagens de tomografia computorizada (TC) e foram obtidas medições semi-automáticas do VAE. O endpoint primário composto foi a admissão na unidade de cuidados intensivos (UCI) ou morte. Resultados: O endpoint primário ocorreu em 25,1% (n=26) dos doentes (idade média 64,8±14,8 anos, 14 homens). Um total de 10 doentes morreu. Os níveis de VAE, PCR, PCT, ferritina e IL-6 foram significativamente superiores nos doentes internados na UCI. Além disso, verificou-se uma correlação positiva entre o VAE e a PCR (r: 0,494, p<0,001), PCT (r: 0,287, p=0,005), ferritina (r: 0,265, p=0,01) e IL-6 (r: 0,311, p=0,005). Na análise de regressão logistica multivariada, os doentes com VAE>102 cm3 tinham maior probabilidade de ter complicações graves. Conclusão: O VAE e os níveis séricos de PCR, IL-6, PCT e ferritina podem avaliar a gravidade da doença e prever o resultado em doentes com COVID-19. O VAE constitui um fator preditivo na admissão dos doentes hospitalizados com COVID-19 numa UCI.

Sarcopenia and Its Prognostic Role on Hospitalization and In-Hospital Mortality in Coronavirus Disease 2019 Patients with At Least One Cardiovascular Risk Factor.

BACKGROUND: The coronavirus disease 2019 infection is a global pandemic that has affected the whole world population. We aimed to evaluate the prognostic role of cross-sectional area, muscle index, and muscle attenuation values in computed tomography-based skeletal groups [erector spinae muscle, pectoralis muscle, and total skeletal muscle] of patients hospitalized for coronavirus disease 2019 and with at least 1 cardiovascular risk factor. METHODS: A total of 232 patients with coronavirus disease 2019 and at least 1 cardiovascular risk factor were enrolled in the study, retrospectively. The cross-sectional area, muscle index, and attenuation of erector spine muscle, pectoralis muscle, and total skeletal muscle were automatically measured on computed tomography images. The study population was assigned into tertiles on the basis of the total SMcsa index. The relationship between the values obtained and the length of hospital stay, admission to intensive care unit, the need for invasive mechani cal ventilation, and mortality was investigated. RESULTS: Admission to intensive care unit, need for invasive mechanical ventilation, and mor tality were higher at tertile 3 groups than in the other groups (all P values <.001). Statistically, all muscle measurements were significantly lower in tertile 3 (P <.001). Diabetes mellitus, hypertension, and total SMcsa index were predictors of in-hospital mortality in patients with coronavirus disease 2019 on the basis of Cox regression analysis. In the Kaplan-Meier analysis for the proportion of survivors relative to the total SMcsa index, tertile 3 had the highest mortal ity (survival rates 57%, P < .001). CONCLUSIONS: Sarcopenia and attendant cardiovascular comorbidities can effectively assess dis ease severity and predict outcome in patients with coronavirus disease 2019.