Shimada Takashi, Maetani Tomoki, Chubachi Shotaro, Tanabe Naoya, Asakura Takanori, Namkoong Ho, Tanaka Hiromu, Azekawa Shuhei, Otake Shiro, Nakagawara Kensuke, Fukushima Takahiro, Watase Mayuko, Shiraishi Yusuke, Terai Hideki, Sasaki Mamoru, Ueda Soichiro, Kato Yukari, Harada Norihiro, Suzuki Shoji, Yoshida Shuichi, Tateno Hiroki, Shimizu Kaoruko, Sato Susumu, Yamada Yoshitake, Jinzaki Masahiro, Hirai Toyohiro, Okada Yukinori, Koike Ryuji, Ishii Makoto, Kimura Akinori, Imoto Seiya, Miyano Satoru, Ogawa Seishi, Kanai Takanori, Fukunaga Koichi
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Cachexia Sarcopenia Muscle. 2025 Feb;16(1):e13721. doi: 10.1002/jcsm.13721.
Chest computed tomography (CT) is a valuable tool for diagnosing and predicting the severity of coronavirus disease 2019 (COVID-19) and assessing extrapulmonary organs. Reduced muscle mass and visceral fat accumulation are important features of a body composition phenotype in which obesity and muscle loss coexist, but their relationship with COVID-19 outcomes remains unclear. In this study, we aimed to investigate the association between the erector spinae muscle (ESM) to epicardial adipose tissue (EAT) ratio (ESM/EAT) on chest CT and disease severity in patients with COVID-19.
We analysed data from 1074 COVID-19 patients enrolled in the Japan COVID-19 Task Force database. The primary outcome was the rate of critical outcomes (requiring high-flow oxygen therapy, invasive ventilator support or death). The incidence of critical outcomes was compared between patients with high and low ESM/EAT ratios.
The low ESM/EAT group (n = 353) had a higher incidence of critical outcomes (13.3% vs. 5.13%, p < 0.001) and mortality (2.55% vs. 0.69%, p = 0.019) than the high ESM/EAT group (n = 721). In multivariable analysis, the low ESM/EAT ratio was associated with critical outcomes (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.22-3.66) independently of the known COVID-19 severity factors including age, sex, body mass index (BMI), smoking history, lifestyle-related comorbidities and pneumonia volume.
The low ESM/EAT ratio in COVID-19 patients can be obtained on chest CT and used to predict critical outcomes after disease onset, demonstrating the importance of detailed body composition assessments in COVID-19 practice.
胸部计算机断层扫描（CT）是诊断和预测2019冠状病毒病（COVID-19）严重程度以及评估肺外器官的重要工具。肌肉量减少和内脏脂肪堆积是肥胖与肌肉减少并存的身体成分表型的重要特征，但其与COVID-19预后的关系尚不清楚。在本研究中，我们旨在探讨胸部CT上竖脊肌（ESM）与心外膜脂肪组织（EAT）的比值（ESM/EAT）与COVID-19患者疾病严重程度之间的关联。
我们分析了日本COVID-19特别工作组数据库中1074例COVID-19患者的数据。主要结局是严重结局的发生率（需要高流量氧疗、有创呼吸机支持或死亡）。比较了ESM/EAT比值高和低的患者发生严重结局的发生率。
与ESM/EAT比值高的组（n = 721）相比，ESM/EAT比值低的组（n = 353）严重结局的发生率（13.3%对5.13%，p < 0.001）和死亡率（2.55%对0.69%，p = 0.019）更高。在多变量分析中，ESM/EAT比值低与严重结局相关（调整后的优势比[aOR]为2.11，95%置信区间[CI]为1.22 - 3.66），独立于已知的COVID-19严重程度因素，包括年龄、性别、体重指数（BMI）、吸烟史、生活方式相关的合并症和肺炎体积。
COVID-19患者的低ESM/EAT比值可通过胸部CT获得，并用于预测疾病发作后的严重结局，这表明在COVID-19临床实践中进行详细身体成分评估的重要性。
