Fat deposits found on pre-pandemic CT exams predict COVID-19 severity

Pericardial and visceral adipose tissue measured on CT scans years before the COVID-19 pandemic independently predicted hospitalization and death from SARS-CoV-2, researchers have reported.

This finding emerged even after accounting for higher body mass index (BMI), diabetes, hypertension, cardiovascular disease, and waist circumference, according to a team led by Nadine Al-Naamani, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia. The group’s study results were published May 25 in BMC Pulmonary Medicine.

“[We found that] greater CT-measured pericardial and abdominal visceral adipose tissue were associated with increased hazards of hospitalization or death from SARS-CoV-2 independent of BMI and clinical cardiometabolic comorbidities,” it noted.

Higher BMI boosts an individual’s risk of respiratory failure and death from SARS-CoV-2 infection, yet it is an imprecise measure and often fails to account for adipose tissue distribution, the investigators explained. They conducted a study that consisted of data from 8,412 patients with at least one CT adipose measure who were included in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), exploring whether pericardial adipose tissue (PAT), abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), or hepatic adipose deposition on CT scans taken between 2000 and 2011 were associated with increased risk of hospitalization or death from SARS-CoV-2. The study’s primary outcome was time from March 1, 2020 to hospitalization or death from SARS-CoV-2 infection.

Of the 8,412 patients, 187 hospitalizations or deaths occurred over a median of 547 days. The group reported the following:

• Both higher PAT and higher VAT were associated with greater hazards of hospitalization or death from SARS-CoV-2.
• These associations remained after adjustment for BMI, diabetes, cardiovascular disease, hypertension, and waist circumference.
• SAT was associated with hospitalization or death, but not after the researchers adjusted for BMI and obesity complications.
• Hepatic adipose deposition was not associated with hospitalization or death.

“Further research should investigate use of CT adipose measures to quantify risk of severe disease from viral infections and to investigate mechanisms linking adiposity to lung injury,” the group concluded.

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