Key result
Elevated VAT/TAT ratio linked to ~6% higher severe COVID-19 risk per percentage point increase.
Why the study?
Elevated BMI is linked to poor COVID-19 progression, presumably due to visceral adipose tissue, but evidence directly investigating intra-abdominal fat and COVID-19 prognosis is sparse.
Does a higher VAT/TAT ratio predict progression to severe disease in adult COVID-19 patients?
Cohort (n=53)
No
Does a higher VAT/TAT ratio predict progression to severe disease in adult COVID-19 patients?
Hazard Ratio: 1.055 (95% CI 1–1.112)
p-value: p=0.049
Visceral fat proportion (VAT/TAT ratio) is superior to BMI in predicting the progression to severe disease in COVID-19 patients.
May refine COVID-19 risk stratification beyond BMI; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Clarification of the risk factors for coronavirus disease 2019 (COVID-19) severity is strongly warranted for global health. Recent studies have indicated that elevated body mass index (BMI) is associated with unfavorable progression of COVID-19. This is assumed to be due to excessive deposition of visceral adipose tissue (VAT); however, the evidence investigating the association between intra-abdominal fat and COVID-19 prognosis is sparse. We therefore investigated whether measuring the amount of intra-abdominal fat is useful to predict the prognosis of COVID-19. METHODS: The present study enrolled 53 consecutive cases of COVID-19 patients aged ≥ 20 years with chest computed tomography (CT) scans. The VAT area, total adipose tissue (TAT) area, and VAT/TAT ratio were estimated using axial CT images at the level of the upper pole of the right kidney. Severe COVID-19 was defined as death or acute respiratory failure demanding oxygen at ≥ 6 L per minute, a high-flow nasal cannula, or mechanical ventilation. The association of VAT/TAT with the incidence of progression to a severe state was estimated as a hazard ratio (HR) using Cox regression analysis. To compare the prediction ability for COVID-19 disease progression between BMI and VAT/TAT, the area under the receiver operating characteristic curve (AUC) of each was assessed. RESULTS: A total of 15 cases (28.3% of the whole study subjects) progressed to severe stages. The incidence of developing severe COVID-19 increased significantly with VAT/TAT (HR per 1% increase = 1.040 (95% CI 1.008-1.074), P = 0.01). After adjustment for potential confounders, the positive association of VAT/TAT with COVID-19 aggravation remained significant (multivariable-adjusted HR = 1.055 (95% CI 1.000-1.112) per 1% increase, P = 0.049). The predictive ability of VAT/TAT for COVID-19 becoming severe was significantly better than that of BMI (AUC of 0.73 for VAT/TAT and 0.50 for BMI; P = 0.0495 for the difference). CONCLUSIONS: A higher ratio of VAT/TAT was an independent risk factor for disease progression among COVID-19 patients. VAT/TAT was superior to BMI in predicting COVID-19 morbidity. COVID-19 patients with high VAT/TAT levels should be carefully observed as high-risk individuals for morbidity and mortality.
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Ogata et al. (2021) conducted a cohort in COVID-19 (n=53). Visceral adipose tissue to total adipose tissue ratio (VAT/TAT) vs. Lower VAT/TAT ratio was evaluated on Progression to severe COVID-19 (death or acute respiratory failure demanding oxygen at ≥ 6 L/min, high-flow nasal cannula, or mechanical ventilation) (HR 1.055, 95% CI 1.000-1.112, p=0.049). An elevated visceral to total adipose tissue ratio (VAT/TAT) independently increased the risk of progression to severe COVID-19, with a multivariable-adjusted HR of 1.055 per 1% increase.
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