Blood Glucose and Epicardial Adipose Tissue at the Hospital Admission as Possible Predictors for COVID-19 Severity

Purpose: to study the possible association of CT-derived quantitative Epicardial Adipose Tissue (EAT) and glycemia at the admission, with severe outcomes in patients with COVID-19. Methods: 229 patients consecutively hospitalized for COVID-19 from March 1 st to June 30 th 2020 were studied.Non contrast chest CT scans, to confirm diagnosis of pneumonia, were performed. EAT volume (cm 3 ) and attenuation (Hounsfield units) were measured using a CT post-processing software. The primary outcome was acute respiratory distress syndrome (ARDS) or in-hospital death. Results: The primary outcome occurred in 56,8% patients. Fasting blood glucose was significantly higher in the group ARDS/death than in the group with better prognosis [114 (98-144) vs 101 (91-118) mg/dl, p=0,001]. EAT volume was higher in patients with vs without the primary outcome [103 (69,25;129,75) vs 78,95 (50,7;100,25) cm 3 , p <0,001] and it was positively correlated with glycemia, PCR, fibrinogen, P/F ratio. In the multivariable logistic regression analysis, age and EAT volume were independently associated with ARDS/death. Glycemia and EAT attenuation were risk factor for ARDS/death with a trend of statistical significance. Conclusions: Our findings suggest that both blood glucose and EAT, measurable and modifiable targets, could allow the early identification of subjects at greater risk of developing severe complications.