Abstracts Division 3
51. Thorax CT-derived muscle area to better 4C mortality in COVID-19 patients?
S.I.J. van Bakel1, H.A. Gietema2 6, P.M. Stassen3, H.R. Gosker1, D. Gach1, J.P. van den Bergh4 7, F.H.M. van Osch1 5, A.M.W.J. Schols1, R.J.H.C.G. Beijers1
1 NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, The Netherlands
2 Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
3 CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht, The Netherlands
4 NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Internal Medicine, Maastricht, The Netherlands
5 Department of Clinical Epidemiology VieCuri Medical Centre, Venlo, The Netherlands
6 Grow School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
7 Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
Introduction
COVID-19 has demonstrated a highly variable disease course, from asymptomatic to severe illness, requiring hospitalization and ICU admission to eventually death. Multiple clinical prediction models have been developed to predict mortality in COVID-19 patients, with the 4C Mortality Score being the best performing model. Separately, CT-derived low muscle and high adipose tissue cross sectional areas (CSA) have been demonstrated to predict adverse outcomes in COVID-19 as well.
Aim
To evaluate the predictive value of CT-derived body composition parameters adjusted for highly predictive clinical parameters on 30-day in-hospital mortality in COVID-19
Materials and methods
This is a retrospective cohort analysis of confirmed COVID-19 patients, who initially presented at the emergency department of one of two participating hospitals during the first wave of the pandemic. Body composition parameters were collected from routinely performed thoracic CT-scans at admission. Pectoralis muscle CSA was manually demarcated based on pre-established thresholds of Hounsfield units at the fourth thoracic vertebra and, when available, skeletal muscle and adipose tissue CSA at the first lumbar vertebra level. Clinical parameters of the 4C mortality score and outcome measures were retrieved from medical records.
Results
Data of 578 patients were analyzed (64.6% male, age 67.7±13.5 years, 18.2% 30-day in-hospital mortality). Patients who deceased within 30 days had significantly lower pectoralis CSA (median(IQR) 32.6(24.4-38.7) vs 35.4(27.2-44.2), p=0.003) than survivors whilst visceral adipose tissue CSA was significantly higher in this group (median(IQR) 113.2(63.8-175.6) vs 148(92.6-221.3), p=0.022). No significant differences regarding L1 muscle and subcutaneous adipose tissue CSA were observed. In multivariate analyses, adjusted for 4C mortality score, pectoralis (HR 0.98 95%CI(0.96-1.00) p=0.041) significantly predicted 30-day in-hospital mortality.
Conclusion
Low CT-derived pectoralis muscle CSA predicts 30-day in-hospital mortality in COVID-19 patients when adjusted for the 4C Mortality score.
NUTRIM | School of Nutrition and Translational Research in Metabolism
NUTRIM aims to contribute to health maintenance and personalised medicine by unraveling lifestyle and disease-induced derangements in metabolism and by developing targeted nutritional, exercise and drug interventions. This is facilitated by a state of the art research infrastructure and close interaction between scientists, clinicians, master and PhD students.
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