Background

Excess visceral fat (VF) or high body mass index (BMI) is risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients.

Aim

To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI.

Methods

We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR.

Results

Among 165 patients with a mean BMI of 26.1 ± 5.4 kg/m², VF was associated with severe COVID-19 (p = 0.022) and SCF was not (p = 0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p = 0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5 cm² (ROC curve), which was independently associated with COVID-19 severity (p < 0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r² = 0.27 vs 0.0008).

Conclusion

Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.

中文翻译：

---

内脏脂肪与 COVID-19 的严重程度相关

背景

过多的内脏脂肪 (VF) 或高体重指数 (BMI) 是严重 COVID-19 的危险因素。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 受体在肥胖患者 VF 中的表达水平高于皮下脂肪 (SCF) 中的表达水平。

目的

表明与 SCF 量或 BMI 相比，内脏脂肪积累可以更好地预测 COVID-19 结果的严重程度。

方法

我们选择了有症状的 COVID-19 患者并进行了计算机断层扫描 (CT) 扫描。重症 COVID-19 被定义为需要机械通气或死亡。通过腹部 CT 扫描切片对脂肪库进行量化，并将测量结果与临床结果相关联。使用 RT-qPCR 对另一组非 COVID-19 受试者的脂肪库中的 ACE 2 mRNA 水平进行定量。

结果

在 165 名平均 BMI 为 26.1 ± 5.4 kg/m ²的患者中，VF 与严重的 COVID-19 相关 ( p  = 0.022)，而 SCF 则不然 ( p  = 0.640)。轻度或重度 COVID-19 患者的皮下脂肪没有差异，重度 COVID-19 患者的 SCF/VF 比值较低 ( p  = 0.010)。^{VF 面积≥128.5 cm 2} （ROC 曲线）对严重 COVID-19 具有最佳预测价值，该值与 COVID-19 严重程度独立相关（p  < 0.001）。在一项探索性分析中，非 COVID-19 患者的 VF 中 ACE 2 mRNA 与 BMI 呈正相关，但 SCF 中则不然（r ²  = 0.27 vs 0.0008）。

结论

严重形式的 COVID-19 与欧洲成年人的高内脏肥胖有关。根据探索性分析，内脏脂肪中的 ACE 2 可能是细胞因子风暴的触发因素，这一点需要通过未来的研究来阐明。