Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Nutr Metab Cardiovasc Dis. 2021 Jun 30;31(7):2156-2164. doi: 10.1016/j.numecd.2021.04.020. Epub 2021 May 3.
Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients.
This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25th to April 19th, 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25th-75th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO/FiO was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO/FiO identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p < 0.0001).
Increased EAT attenuation, a marker of EAT inflammation, but not obesity or EAT volume, predicts critical COVID-19.
NCT04318366.
肥胖相关的心血管代谢危险因素与 COVID-19 的严重程度和结局相关。心外膜脂肪组织 (EAT) 与心血管代谢紊乱有关，是促炎细胞因子的来源，也是内脏肥胖的标志物。我们研究了 COVID-19 患者中 EAT 特征与结局的关系。
这是对一项大型前瞻性研究的事后分析，纳入了 2020 年 2 月 25 日至 4 月 19 日期间因确诊 SARS-CoV-2 感染而入住意大利米兰圣拉斐尔大学医院的所有成年患者（≥18 岁），这些患者接受了胸部计算机断层扫描（CT）检查以确诊 COVID-19 肺炎，并且有可供分析的人体测量数据。在 CT 扫描上测量 EAT 体积和衰减（EAT-At，EAT 炎症的标志物）。主要结局为重症疾病，定义为入住重症监护病房（ICU）、有创通气或死亡。使用 Cox 回归和回归树分析评估临床变量、EAT 特征与重症疾病之间的关系。共纳入 192 例患者（中位数[25 至 75 百分位数]年龄 60 岁[53 至 70]，76%为男性）。合并症包括超重/肥胖（70%）、动脉高血压（40%）和糖尿病（16%）。多变量 Cox 回归分析显示，EAT-At（HR 1.12[1.04-1.21]）独立预测重症疾病，而 PaO/FiO 升高具有保护作用（HR 0.996[95%CI 0.993；1.00]）。CRP、入院时血糖、EAT-At 和 PaO/FiO 确定了五个风险组，与死亡或入住 ICU 的时间显著不同（对数秩检验 p<0.0001）。
EAT 衰减增加，即 EAT 炎症的标志物，而不是肥胖或 EAT 体积，可预测 COVID-19 的重症程度。
NCT04318366。
