The Impact of Thoracic CT Findings, Adiposity Parameters, and Laboratory Data on COVID-19 Prognosis

Abstract

Aim: Numerous studies have been conducted concerning the clinical, laboratory, and radiological methods and markers to predict the prognosis of Coronavirus disease 2019 (COVID-19). In this study, we aim to explore the impact of COVID-19 severity scores, adiposity parameters, and laboratory findings on the prognosis of COVID-19. Material and Method: A retrospective study was performed with 98 patients who were both computed tomography (CT) and polymerase chain reaction positive. Clinical outcomes, laboratory findings, thorax CT findings, and adiposity parameters (such as hepatic steatosis and visceral fat amount) obtained from thorax CTs were evaluated. Results: The frequency of hepatic steatosis, lung severity score, and C-reactive protein (CRP) levels were higher, whereas lymphocyte count was lower in hospitalized patients than in patients treated at home. Among hospitalized patients, in addition to previous laboratory and radiological findings d-dimer and ferritin levels were higher in patients requiring intensive care. Among patients admitted to intensive care unit (ICU), the visceral to subcutaneous adipose tissue ratio was higher in patients who died than in patients who survived; none of the other parameters showed a significant difference. Conclusion: COVID-19 CT score, adiposity parameters, and laboratory results were related to the prognosis of COVID-19. These results align with those of other recent research. A formula based on patient age, CT score, and CRP levels can be employed to determine if the patient requires hospital admission.

Keywords

• COVID-19
• quantitative evaluation
• tomography
• visceral adipose tissue
• subcutaneous adipose tissue

Kaynakça

1. Alberca RW, Oliveira L de M, Branco ACCC, et al. Obesity as a risk factor for COVID-19: an overview. Crit Rev Food Sci Nutr. 2021;61:2262-76.
2. Deng M, Qi Y, Deng L, et al. Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study. Obesity. 2020;28:1815-25.
3. de Siqueira JVV, Almeida LG, Zica, BO et al. Impact of obesity on hospitalizations and mortality, due to COVID-19: a systematic review. Obes Res Clin Pract. 2020;14:398-403.
4. 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;15:89-92.
5. Favre G, Legueult K, Pradier C, et al. Visceral fat is associated to the severity of COVID-19. Metabolism. 2021;115:154440.
6. 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.
7. Battaglini D, Lopes-Pacheco M, Castro-Faria-Neto HC, et al. Laboratory biomarkers for diagnosis and prognosis in COVID-19. Front Immunol. 2022;13:857573.
8. Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on reporting chest CT findings related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging. 2020;35:219-27.

9. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30:4407-16.
10. Kim SS, Kim JH, Jeong WK, et al. Semiautomatic software for measurement of abdominal muscle and adipose areas using computed tomography: a STROBE-compliant article. Medicine (Baltimore). 2019;98:e15867.
11. Yang R, Li X, Liu H, et al. Chest ct severity score: an imaging tool for assessing severe COVID-19. Radiol Cardiothorac Imaging. 2020;2:e200047.
12. Figliozzi S, Masci PG, Ahmadi N, et al. Predictors of adverse prognosis in COVID-19: a systematic review and meta-analysis. Eur J Clin Invest. 2020;50:e13362.
13. Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol. 2021;31:1-10.
14. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80:e14-8.
15. Palmieri L, Vanacore N, Donfrancesco C, et al. Clinical characteristics of hospitalized individuals dying with COVID-19 by age group in Italy. J Gerontol A Biol Sci Med Sci. 2020;75:1796-800.
16. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395:1054-62. Erratum in: Lancet. 2020;395:1038.
17. Leung C. Risk factors for predicting mortality in elderly patients with COVID-19: a review of clinical data in China. Mech Ageing Dev. 2020;188:111255.
18. Kaushal K, Kaur H, Sarma P, et al. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care. 2022;67:172-81.
19. Cheng L, Li H, Li L, et al. Ferritin in the coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. J Clin Lab Anal. 2020;34:e23618.
20. Pepys MB. C-reactive protein predicts outcome in COVID-19: is it also a therapeutic target?. Eur Heart J. 2021;42:2280-3.
21. Yitbarek GY, Walle Ayehu G, Asnakew S, et al. The role of C-reactive protein in predicting the severity of COVID-19 disease: a systematic review. SAGE Open Med. 2021;9:20503121211050755.
22. Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis. 2020;95:304-7.
23. Torti FM, Torti SV. Regulation of ferritin genes and protein. Blood. 2002;99:3505-16.
24. Poudel A, Poudel Y, Adhikari A, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One. 2021;16:e0256744.
25. Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the fleischner society. Chest. 2020;158:106-16.
26. Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30:6808-17.
27. Parlak S, Çıvgın E, Beşler M, Kayıpmaz A. The effect of hepatic steatosis on COVID-19 severity: chest computed tomography findings. Saudi J Gastroenterol. 2021;27:105-10.
28. Palomar-Lever A, Barraza G, Galicia-Alba J, et al. Hepatic steatosis as an independent risk factor for severe disease in patients with COVID-19: a computed tomography study. JGH Open. 2020;4:1102-7.
29. Wieckowska A, Papouchado BG, Li ZZ, et al. Increased hepatic and circulating interleukin-6 levels in human nonalcoholic steatohepatitis. Am J Gastroenterol. 2008;103:1372-9.
30. Kuk JL, Katzmarzyk PT, Nichaman MZ, et al. Visceral fat is an independent predictor of all-cause mortality in men. Obesity. 2006;14:336-41.
31. Zhang X, Shu XO, Gong Y, et al. Abdominal adiposity and mortality in Chinese women. Arch Intern Med. 2007;167:886-92.
32. Iacobellis G, Malavazos AE, Ferreira T. COVID-19 rise in younger adults with obesity: visceral adiposity can predict the risk. Obesity. 2020;28:1795.
33. Petrakis D, Margină D, Tsarouhas K, et al. Obesity a risk factor for increased COVID 19 prevalence, severity and lethality (Review). Mol Med Rep. 2020;22:9-19.
34. Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-α, and IL-6. Diabetes Res Clin Pract. 2005;69:29-35.
35. Fain JN. Release of interleukins and other inflammatory cytokines by human adipose tissue is enhanced in obesity and primarily due to the nonfat cells. Vitam Horm. 2006;74:443-77.
36. Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-α, and IL-6. Diabetes Res Clin Pract. 2005;69:29-35.