The effect of body composition on prognosis in critically ill COVID-19 patients

Abstract

Aim: Although limited risk factors were observed with the accumulated evidence during the SARS-CoV-2 (COVID-19) pandemic, there is still a lack of evidence for markers distinguishing asymptomatic-mild disease from severe disease. In this study, we aimed to evaluate the prognostic impact of sarcopenia and visceral adipose tissue in ICU patients treated for COVID-19. Material and Methods: The study designed as a retrospective cross-sectional study for evaluating the effect of prognostic radiologic features in COVID-19 infected patients. The patient characteristics, intubation status and dates, transfer to ICU, and last control or death dates were recorded. Axial CT images, including all abdominal muscles, total skeletal muscle area, were calculated. The total and psoas sarcopenia index (PSI) was calculated by dividing the square of the patient’s height by the square meter (cm2/m2). Also, axial CT images of the body fat subcutaneous adipose and visceral adipose tissue distribution areas were calculated in cm2 using threshold values of-30 to-190 for adipose tissue. Results: In the study population, there were nine deaths that occurred among male patients. In univariate analysis, chronic obstructive pulmonary disease and PSI were found to be related to prognosis. The median survival was 14 days in PSI low group. The prognostic effect of the PSI was still valid in the male population. Other factors had no relationship with survival in univariate analysis. In multivariate analysis, the prognostic effect of TSI and PSI was related to prognosis, while COPD lost its prognostic effect. Discussion: In this study, we found a new prognostic factor in critically ill COVID-19 patients, which may be a new area of interest. In contrast to other studies, we found no effect of BMI and visceral adipose tissue on mortality in COVID-19 patients treated in ICU. This feasible method needs further evaluation and validation with prospective studies in a large patient population.