Abstract
Background: This study aims to reveal the relationship between lung involvement and visceral adipose tissue changes between chest-computed tomography (CT) scans taken in short intervals in COVID-19 patients.
Methods: The retrospective study included 52 patients who tested positive for SARS-CoV-2. All patients had two chest CT exams. Lung involvement measurements were calculated by using an artificial intelligence tool. Visceral and subcutaneous fat tissue was measured at the level of the first lumbar vertebra on chest CT. Additionally, demographic and laboratory data were collected.
Results: 52 patients were included (36.5% female, mean age 50). Visceral fat area and visceral fat thickness changes were significantly positive predictors of total lung involvement changes (p=0.033, p=0.00024). Subcutaneous fat area and subcutaneous fat thickness changes were not associated with lung involvement change (p>0.05). CRP, IL-6, d-dimer, and ferritin levels were higher in patients who need intensive care units.
Conclusion: Visceral adipose tissue changes may indicate that it can have a role as a reservoir of virus involvement.
[1]
World Health Organization. Coronavirus disease (COVID-19) dashboard Available from: https:// covid19.who.int/ (Accessed on: June 15, 2021).
[2]
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ 2020; 368: m1091.
[3]
Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. BMJ 2020; 369: m1966.
[http://dx.doi.org/10.1136/bmj.m1966] [PMID: 32444366]
[http://dx.doi.org/10.1136/bmj.m1966] [PMID: 32444366]
[4]
Kalligeros M, Shehadeh F, Mylona EK, et al. Association of obesity with disease severity among patients with coronavirus disease 2019. Obesity 2020; 28(7): 1200-4.
[http://dx.doi.org/10.1002/oby.22859] [PMID: 32352637]
[http://dx.doi.org/10.1002/oby.22859] [PMID: 32352637]
[5]
Ziegler CGK, Allon SJ, Nyquist SK, et al. SARS-CoV-2 receptor ACE2 is an interferon-stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues. Cell 2020; 181(5): 1016-1035.e19.
[http://dx.doi.org/10.1016/j.cell.2020.04.035] [PMID: 32413319]
[http://dx.doi.org/10.1016/j.cell.2020.04.035] [PMID: 32413319]
[6]
Al-Benna S. Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients. Obes Med 2020; 19: 100283.
[http://dx.doi.org/10.1016/j.obmed.2020.100283] [PMID: 32835126]
[http://dx.doi.org/10.1016/j.obmed.2020.100283] [PMID: 32835126]
[7]
Zhang Y, Somers KR, Becari C, et al. Comparative expression of renin-angiotensin pathway proteins in visceral versus subcutaneous fat. Front Physiol 2018; 9: 1370.
[http://dx.doi.org/10.3389/fphys.2018.01370] [PMID: 30364113]
[http://dx.doi.org/10.3389/fphys.2018.01370] [PMID: 30364113]
[8]
Kruglikov IL, Scherer P. The Role of Adipocytes and Adipocyte-like Cells in the Severity of COVID-19 Infections. Silver Spring: Obes 2020.
[http://dx.doi.org/10.1002/oby.22856]
[http://dx.doi.org/10.1002/oby.22856]
[9]
Iacobellis G, Malavazos AE, Ferreira T. COVID-19 rise in younger adults with obesity: Visceral adiposity can predict the risk. Obesity 2020; 28(10): 1795.
[http://dx.doi.org/10.1002/oby.22951] [PMID: 32619294]
[http://dx.doi.org/10.1002/oby.22951] [PMID: 32619294]
[10]
Favre G, Legueult K, Pradier C, et al. Visceral fat is associated to the severity of COVID-19. Metabolism 2021; 115: 154440.
[http://dx.doi.org/10.1016/j.metabol.2020.154440] [PMID: 33246009]
[http://dx.doi.org/10.1016/j.metabol.2020.154440] [PMID: 33246009]
[11]
Pediconi F, Rizzo V, Schiaffino S, et al. Visceral adipose tissue area predicts intensive care unit admission in COVID-19 patients. Obes Res Clin Pract 2021; 15(1): 89-92.
[http://dx.doi.org/10.1016/j.orcp.2020.12.002] [PMID: 33358147]
[http://dx.doi.org/10.1016/j.orcp.2020.12.002] [PMID: 33358147]
[12]
Banerjee M, Gupta S, Sharma P, Shekhawat J, Gauba K. Obesity and COVID-19: A fatal alliance. Indian J Clin Biochem 2020; 35(4): 410-7.
[http://dx.doi.org/10.1007/s12291-020-00909-2] [PMID: 32837031]
[http://dx.doi.org/10.1007/s12291-020-00909-2] [PMID: 32837031]
[13]
Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: A critical review of methods for visceral adipose tissue analysis. Br J Radiol 2012; 85(1009): 1-10.
[http://dx.doi.org/10.1259/bjr/38447238] [PMID: 21937614]
[http://dx.doi.org/10.1259/bjr/38447238] [PMID: 21937614]
[14]
Chen X, Zhao B, Qu Y, et al. Detectable serum severe acute respiratory syndrome coronavirus 2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 level in critically ill patients with coronavirus disease 2019. Clin Infect Dis 2020; 71(8): 1937-42.
[http://dx.doi.org/10.1093/cid/ciaa449] [PMID: 32301997]
[http://dx.doi.org/10.1093/cid/ciaa449] [PMID: 32301997]
[15]
Pasquarelli-do-Nascimento G, Braz-de-Melo HA, Faria SS, Santos IO, Kobinger GP, Magalhães KG. Hypercoagulopathy and adipose tissue exacerbated inflammation may explain higher mortality in COVID-19 patients with obesity. Front Endocrinol 2020; 11: 530.
[http://dx.doi.org/10.3389/fendo.2020.00530] [PMID: 32849309]
[http://dx.doi.org/10.3389/fendo.2020.00530] [PMID: 32849309]
[16]
Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol 2020; 146(1): 128-136.e4.
[http://dx.doi.org/10.1016/j.jaci.2020.05.008] [PMID: 32425269]
[http://dx.doi.org/10.1016/j.jaci.2020.05.008] [PMID: 32425269]
[17]
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46(5): 846-8.
[http://dx.doi.org/10.1007/s00134-020-05991-x] [PMID: 32125452]
[http://dx.doi.org/10.1007/s00134-020-05991-x] [PMID: 32125452]
[18]
Tang Y, Liu J, Zhang D, Xu Z, Ji J, Wen C. Cytokine storm in COVID-19: The current evidence and treatment strategies. Front Immunol 2020; 11: 1708.
[http://dx.doi.org/10.3389/fimmu.2020.01708] [PMID: 32754163]
[http://dx.doi.org/10.3389/fimmu.2020.01708] [PMID: 32754163]
[19]
Watanabe M, Caruso D, Tuccinardi D, et al. Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. Metabolism 2020; 111: 154319.
[http://dx.doi.org/10.1016/j.metabol.2020.154319] [PMID: 32712222]
[http://dx.doi.org/10.1016/j.metabol.2020.154319] [PMID: 32712222]
[20]
Petersen A, Bressem K, Albrecht J, et al. The role of visceral adiposity in the severity of COVID-19: Highlights from a unicenter cross-sectional pilot study in Germany. Metabolism 2020; 110: 154317.
[http://dx.doi.org/10.1016/j.metabol.2020.154317] [PMID: 32673651]
[http://dx.doi.org/10.1016/j.metabol.2020.154317] [PMID: 32673651]
[21]
Chandarana H, Dane B, Mikheev A, Taffel MT, Feng Y, Rusinek H. Visceral adipose tissue in patients with COVID-19: risk stratification for severity. Abdom Radiol 2021; 46(2): 818-25.
[http://dx.doi.org/10.1007/s00261-020-02693-2] [PMID: 32748252]
[http://dx.doi.org/10.1007/s00261-020-02693-2] [PMID: 32748252]
[22]
Sosna M, Młynarska A, Stasiów B, Młynarski R. Association between lung opacities and visceral fat in COVID-19 patients. Pol J Radiol 2023; 88(1): 119-23.
[http://dx.doi.org/10.5114/pjr.2023.125407] [PMID: 36910886]
[http://dx.doi.org/10.5114/pjr.2023.125407] [PMID: 36910886]
