Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.
Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico.
Int J Obes (Lond). 2022 Apr;46(4):866-873. doi: 10.1038/s41366-021-01050-7. Epub 2022 Jan 11.
Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes.
We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes.
EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01-1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67-28.0%) and 5.1% (95% CI 0.19-14.0%) of the effect of age and 19.4% (95% CI 4.67-63.0%) and 12.8% (95% CI 0.03-46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19.
EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.
肥胖和内脏肥胖与 COVID-19 的不良结局有关。由于心外膜脂肪组织（EAT）靠近心脏和肺部，因此其含量可能具有相关意义。在这里，我们探讨了 EAT 增加 COVID-19 不良结局风险的作用。
我们纳入了 748 名在墨西哥城一家参考中心就诊的 COVID-19 患者。使用胸部 CT 扫描测量 EAT 厚度、胸下部和心包外脂肪。我们根据是否存在肥胖，探讨了每个胸壁脂肪组织隔间与 COVID-19 死亡率和严重 COVID-19（定义为死亡率和需要侵入性机械通气）之间的关联。中介分析评估了 EAT 在促进年龄、体重指数和心脏肌钙蛋白水平与 COVID-19 结局之间的作用。
EAT 厚度与 COVID-19 死亡率增加相关（HR 1.18，95%CI 1.01-1.39），独立于年龄、性别、合并症和 BMI。EAT 增加与较低的 SpO2 和 PaFi 指数以及较高的心脏肌钙蛋白、D-二聚体、纤维蛋白原、C 反应蛋白和 4C 严重程度评分相关，与肥胖无关。EAT 介导了年龄和 BMI 对插管和死亡率的影响的 13.1%（95%CI 3.67-28.0%）和 5.1%（95%CI 0.19-14.0%），19.4%（95%CI 4.67-63.0%）和 12.8%（95%CI 0.03-46.0%）。EAT 还介导了心脏肌钙蛋白升高对 COVID-19 期间心肌梗死的影响。
EAT 是 COVID-19 严重程度和死亡率的独立危险因素，与肥胖无关。EAT 部分介导了年龄、BMI 和心脏肌钙蛋白升高对 COVID-19 不良结局的影响。
