Computed Tomography Highlights Increased Visceral Adiposity Associated With Critical Illness in COVID-19

Obese subjects with coronavirus disease 2019 (COVID-19) are at increased risk of requiring critical care (1), suggesting that excess body fat associates with greater disease severity. BMI does not discriminate between fat and lean body mass and poorly reflects fat distribution. Cardiometabolic diseases and increased systemic inflammation, two conditions associated with visceral adiposity, are also linked to COVID-19 severity and fatality (1,2). The aim of this study was to assess the relationship between abdominal fat distribution and COVID-19 severity. We hypothesized that excess visceral adipose tissue (VAT), as identified by an increased VAT to subcutaneous adipose tissue (SAT) ratio (VAT/SAT), is associated with COVID-19 severity, as defined by intensive care unit (ICU) admission. This was a single-center cohort study of 441 patients consecutively admitted to the Emergency Department (ED) of the Trauma Center Public Hospital Bufalini, Cesena, Italy, between 26 February and 6 April 2020 for a clinical suspicion of COVID-19. Of these patients, 144 had confirmed COVID-19 based on positive RT-PCR from a nasal and/or throat swab together with high-resolution computed tomography (HR-CT) findings suggestive of COVID-19 pneumonia. Of those, 61 (42%) were admitted to ICU (ICU-COVID-19 group). One-hundred thirty-six patients evaluated in the ED for clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) …