Background and aims

Overall obesity has recently been established as an independent risk factor for critical illness in patients with coronavirus disease 2019 (COVID-19). The role of fat distribution and especially that of visceral fat, which is often associated with metabolic syndrome, remains unclear. Therefore, this study aims at investigating the association between fat distribution and COVID-19 severity.

Methods

Thirty patients with COVID-19 and a mean age of 65.6 ± 13.1 years from a level-one medical center in Berlin, Germany, were included in the present cross-sectional analysis. COVID-19 was confirmed by polymerase chain reaction (PCR) from nasal and throat swabs. A severe clinical course of COVID-19 was defined by hospitalization in the intensive care unit (ICU) and/or invasive mechanical ventilation. Fat was measured at the level of the first lumbar vertebra on routinely acquired low-dose chest computed tomography (CT).

Results

An increase in visceral fat area (VFA) by ten square centimeters was associated with a 1.37-fold higher likelihood of ICU treatment and a 1.32-fold higher likelihood of mechanical ventilation (adjusted for age and sex). For upper abdominal circumference, each additional centimeter of circumference was associated with a 1.13-fold higher likelihood of ICU treatment and a 1.25-fold higher likelihood of mechanical ventilation.

Conclusions

Our proof-of-concept study suggests that visceral adipose tissue and upper abdominal circumference specifically increase the likelihood of COVID-19 severity. CT-based quantification of visceral adipose tissue and upper abdominal circumference in routine chest CTs may therefore be a simple tool for risk assessment in COVID-19 patients.

中文翻译：

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内脏肥胖在COVID-19严重程度中的作用：德国一项单中心横截面试验研究的重点。

背景和目标

最近，整体肥胖已被确定为2019年冠状病毒病（COVID-19）患者严重疾病的独立危险因素。脂肪分布的作用，尤其是内脏脂肪，通常与代谢综合征有关，目前尚不清楚。因此，本研究旨在研究脂肪分布与COVID-19严重程度之间的关系。

方法

本断面分析包括来自德国柏林一级医疗中心的30例COVID-19患者，平均年龄为65.6±13.1岁。通过聚合酶链反应（PCR）从鼻和咽拭子中确认了COVID-19。重症监护病房（ICU）的住院和/或有创机械通气定义了COVID-19的严重临床过程。在常规获得的低剂量胸部计算机断层扫描（CT）上测量第一腰椎水平的脂肪。

结果

内脏脂肪面积（VFA）增加10平方厘米与ICU治疗的可能性高1.37倍，机械通气的可能性高1.32倍（根据年龄和性别调整）。对于上腹围，每增加一厘米的围，与ICU治疗的可能性高1.13倍，而机械通气的可能性高1.25倍。

结论

我们的概念验证研究表明，内脏脂肪组织和上腹围特别增加了COVID-19严重程度的可能性。因此，常规胸部CT中基于CT的内脏脂肪组织和上腹围的量化可能是COVID-19患者进行风险评估的简单工具。