COVID-19 diabetic adults are at increased risk of severe forms irrespective of obesity. In patients with type-II diabetes, fat distribution is characterized by visceral and ectopic adipose tissues expansion, resulting in systemic inflammation, which may play a role in driving the COVID-19 cytokine storm. Our aim was to determine if cardiac adipose tissue, combined to interleukin-6 levels, could predict adverse short-term outcomes, death and ICU requirement, in COVID-19 diabetic patients during the 21 days after admission. Eighty one consecutive patients with type-II diabetes admitted for COVID-19 were included. Interleukin-6 measurement and chest computed tomography with total cardiac adipose tissue index (CATi) measurement were performed at admission. The primary outcome was death during the 21 days following admission while intensive care requirement with or without early death (ICU-R) defined the secondary endpoint. Associations of CATi and IL-6 and threshold values to predict the primary and secondary endpoints were determined. Of the enrolled patients (median age 66 years [IQR: 59–74]), 73% male, median body mass index (BMI) 27 kg/m2 [IQR: 24–31]) 20 patients had died from COVID-19, 20 required intensive care and 41 were in conventional care at day 21 after admission. Increased CATi and IL-6 levels were both significantly related to increased early mortality (respectively OR = 6.15, p = 0.002; OR = 18.2, p < 0.0001) and ICU-R (respectively OR = 3.27, p = 0.01; OR = 4.86, p = 0.002). These associations remained significant independently of age, sex, BMI as well as troponin-T level and pulmonary lesion extension in CT. We combined CATi and IL-6 levels as a multiplicative interaction score (CATi*IL-6). The cut-point for this score was ≥ 6386 with a sensitivity of 0.90 and a specificity of 0.87 (AUC = 0.88) and an OR of 59.6 for early mortality (p < 0.0001). Cardiac adipose tissue index and IL-6 determination at admission could help physicians to better identify diabetic patients with a potentially severe and lethal short term course irrespective of obesity. Diabetic patients with high CATi at admission, a fortiori associated with high IL-6 levels could be a relevant target population to promptly initiate anti-inflammatory therapies.

中文翻译：

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入院时心脏脂肪组织体积和 IL-6 水平是 COVID-19 糖尿病患者严重程度和短期死亡率的补充预测因子

无论是否肥胖，COVID-19 糖尿病成人患严重疾病的风险都会增加。在 II 型糖尿病患者中，脂肪分布的特点是内脏和异位脂肪组织扩张，导致全身炎症，这可能在驱动 COVID-19 细胞因子风暴中发挥作用。我们的目的是确定心脏脂肪组织与白细胞介素 6 水平结合是否可以预测 COVID-19 糖尿病患者在入院后 21 天内的不良短期结果、死亡和 ICU 需求。包括 81 名因 COVID-19 入院的连续 II 型糖尿病患者。入院时进行了白细胞介素 6 测量和胸部计算机断层扫描和心脏总脂肪组织指数 (CATi) 测量。主要结局是入院后 21 天内的死亡，而有或没有早期死亡的重症监护要求 (ICU-R) 定义了次要终点。确定了 CATi 和 IL-6 的关联以及预测主要和次要终点的阈值。在入选患者中（中位年龄 66 岁 [IQR：59-74]），73% 为男性，中位体重指数 (BMI) 27 kg/m2 [IQR：24-31]）20 名患者死于 COVID-19，入院后第 21 天，20 人需要重症监护，41 人接受常规治疗。CATi 和 IL-6 水平升高均与早期死亡率（分别为 OR = 6.15，p = 0.002；OR = 18.2，p < 0.0001）和 ICU-R（分别为 OR = 3.27，p = 0.01；OR = 4.86）显着相关, p = 0.002)。这些关联在独立于年龄、性别、CT 中的 BMI 以及肌钙蛋白-T 水平和肺部病变扩展。我们将 CATi 和 IL-6 水平组合为乘法交互评分 (CATi*IL-6)。该评分的分界点≥ 6386，敏感性为 0.90，特异性为 0.87 (AUC = 0.88)，早期死亡率的 OR 为 59.6 (p < 0.0001)。入院时心脏脂肪组织指数和 IL-6 测定可以帮助医生更好地识别患有潜在严重和致命短期病程的糖尿病患者，而不管是否肥胖。入院时具有高 CATi 的糖尿病患者，尤其与高 IL-6 水平相关的糖尿病患者可能是迅速启动抗炎治疗的相关目标人群。该评分的分界点≥ 6386，敏感性为 0.90，特异性为 0.87 (AUC = 0.88)，早期死亡率的 OR 为 59.6 (p < 0.0001)。入院时心脏脂肪组织指数和 IL-6 测定可以帮助医生更好地识别患有潜在严重和致命短期病程的糖尿病患者，而不管是否肥胖。入院时具有高 CATi 的糖尿病患者，尤其与高 IL-6 水平相关的糖尿病患者可能是迅速启动抗炎治疗的相关目标人群。该评分的分界点≥ 6386，敏感性为 0.90，特异性为 0.87 (AUC = 0.88)，早期死亡率的 OR 为 59.6 (p < 0.0001)。入院时心脏脂肪组织指数和 IL-6 测定可以帮助医生更好地识别患有潜在严重和致命短期病程的糖尿病患者，而不管是否肥胖。入院时具有高 CATi 的糖尿病患者，尤其与高 IL-6 水平相关的糖尿病患者可能是迅速启动抗炎治疗的相关目标人群。入院时心脏脂肪组织指数和 IL-6 测定可以帮助医生更好地识别患有潜在严重和致命短期病程的糖尿病患者，而不管是否肥胖。入院时具有高 CATi 的糖尿病患者，尤其与高 IL-6 水平相关的糖尿病患者可能是迅速启动抗炎治疗的相关目标人群。入院时心脏脂肪组织指数和 IL-6 测定可以帮助医生更好地识别患有潜在严重和致命短期病程的糖尿病患者，而不管是否肥胖。入院时具有高 CATi 的糖尿病患者，尤其与高 IL-6 水平相关的糖尿病患者可能是迅速启动抗炎治疗的相关目标人群。