Pericardial Fat Tissue as a Predictor of the Severity of Acute Coronavirus Infection COVID-19

Coronavirus disease 2019 (COVID-19) and obesity remain pressing global health concerns. Identifying predictors of severe disease is of particular importance. Pericardial fat tissue (PFT) is a known source of metainflammation due to its secretion of adipocytokines and inflammatory mediators. Moreover, cytokine storm plays a major role in COVID-19-related mortality. This study aimed to investigate the association between preexisting PFT volume and inflammatory markers in patients with COVID-19.

The study included 290 hospitalized patients with confirmed COVID-19 infection. Based on PFT volume (above or below 3.45 cm³), patients were divided into two groups: with and without pericardial obesity (PO), consisting of 132 and 158 individuals, respectively. Clinical, laboratory, and imaging data were analyzed. Statistical analysis was performed in Statistica 12.0.

Significant intergroup differences were observed in the PO group for the following variables: male sex (P < 0.001), body mass index (BMI) (P < 0.001), obesity (P < 0.001), and history of diabetes mellitus (P = 0.003). No significant differences were found in lung computed tomography (CT) severity scores. However, patients with PO showed significantly lower oxygen saturation (SpO₂) levels (P = 0.014) and a higher frequency of SpO₂ ≤ 93% (P = 0.012). Ferritin levels were significantly higher in the PO group (median 440 (274.00 - 552.70) vs. 292.55 (156.00 - 521.50), P = 0.010). Linear correlation analysis revealed a positive association between PFT volume and age, BMI, glucose, ferritin, C-reactive protein, and D-dimer levels, and a negative correlation with oxygen saturation. Multivariate logistic regression confirmed an independent association between PFT volume and SpO₂ ≤ 93%. Receiver operating characteristic (ROC) analysis identified a threshold PFT volume of 3.45 cm³ for predicting increased risk of severe COVID-19 (SpO₂ ≤ 93%), with sensitivity of 66.7%, specificity of 65.0%, and area under the curve (AUC) of 0.710 (95% confidence interval (CI): 0.551 - 0.868, P < 0.001).

Our data suggest that a PFT volume greater than 3.45 cm³ is a potential predictor of severe COVID-19.