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CT Scan-Derived Muscle, But Not Fat, Area Independently Predicts Mortality in COVID-19
Sophie I J van Bakel1, Hester A Gietema2, Patricia M Stassen3
1Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
Insights
Low pectoralis muscle cross-sectional area (CSA) on CT scans predicts higher 30-day mortality in COVID-19 patients. This finding is independent of the 4C Mortality Score, offering a new predictor for severe outcomes.
Area of Science:
- Radiology
- Pulmonology
- Critical Care Medicine
Background:
- COVID-19 presents a wide spectrum of disease severity.
- The 4C Mortality Score accurately predicts mortality in COVID-19 patients.
- Low muscle and high adipose tissue areas on CT scans are linked to adverse COVID-19 outcomes.
Purpose of the Study:
- To determine if CT scan-derived muscle and adipose tissue cross-sectional areas (CSAs) are associated with 30-day in-hospital mortality in COVID-19 patients.
- To assess the independence of this association from the 4C Mortality Score.
Main Methods:
- Retrospective cohort analysis of 578 COVID-19 patients during the first pandemic wave.
- Skeletal muscle and adipose tissue CSAs were measured from routine chest CT scans at admission.
- Pectoralis muscle CSA was manually demarcated at the fourth thoracic vertebra; skeletal muscle and adipose tissue CSA at the first lumbar vertebra.
Main Results:
- Patients who died within 30 days had significantly lower pectoralis CSA (median 32.6 vs 35.4) and higher visceral adipose tissue CSA (median 151.1 vs 112.9) compared to survivors.
- Low pectoralis muscle CSA remained a significant predictor of 30-day mortality after adjustment for the 4C Mortality Score (HR 0.98, P=0.038).
Conclusions:
- Low pectoralis muscle CSA, measured via CT scan, is a significant independent predictor of 30-day in-hospital mortality in COVID-19 patients.
- This imaging biomarker may aid in risk stratification for severe COVID-19 outcomes.
Background:
COVID-19 has demonstrated a highly variable disease course, from asymptomatic to severe illness and eventually death. Clinical parameters, as included in the 4C Mortality Score, can predict mortality accurately in COVID-19. Additionally, CT scan-derived low muscle and high adipose tissue cross-sectional areas (CSAs) have been associated with adverse outcomes in COVID-19.
Research Question:
Are CT scan-derived muscle and adipose tissue CSAs associated with 30-day in-hospital mortality in COVID-19, independent of 4C Mortality Score?
Study Design And Methods:
This was a retrospective cohort analysis of patients with COVID-19 seeking treatment at the ED of two participating hospitals during the first wave of the pandemic. Skeletal muscle and adipose tissue CSAs were collected from routine chest CT-scans at admission. Pectoralis muscle CSA was demarcated manually at the fourth thoracic vertebra, and skeletal muscle and adipose tissue CSA was demarcated at the first lumbar vertebra level. Outcome measures and 4C Mortality Score items were retrieved from medical records.
Results:
Data from 578 patients were analyzed (64.6% men; mean age, 67.7 ± 13.5 years; 18.2% 30-day in-hospital mortality). Patients who died within 30 days demonstrated lower pectoralis CSA (median, 32.6 [interquartile range (IQR), 24.3-38.8] vs 35.4 [IQR, 27.2-44.2]; P = .002) than survivors, whereas visceral adipose tissue CSA was higher (median, 151.1 [IQR, 93.6-219.7] vs 112.9 [IQR, 63.7-174.1]; P = .013). In multivariate analyses, low pectoralis muscle CSA remained associated with 30-day in-hospital mortality when adjusted for 4C Mortality Score (hazard ratio, 0.98; 95% CI, 0.96-1.00; P = .038).
Interpretation:
CT scan-derived low pectoralis muscle CSA is associated significantly with higher 30-day in-hospital mortality in patients with COVID-19 independently of the 4C Mortality Score.
