Abdominal Obesity Phenotype Predicts COVID-19 Chest X-Ray Severity Score better than General Obesity

Malavazos, Alexis Elias Secchi Francesco Basilico Sara Capitanio Gloria Boveri Sara Milani Valentina Dubini Carola Schiaffino Simone Morricone Lelio Foschini Chiara Gobbo Giulia Piccinni Rosangela Saibene Alessandro Sardanelli Francesco Menicanti Lorenzo Guazzi Marco Dong Chuanhui Romanelli Massimiliano Marco Corsi Carruba Michele Iacobellis Gianluca

Purpose: Chest x-ray (CXR) severity score and general obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score has not yet been fully explored.MethodsThis retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19.ResultsPatients with abdominal obesity had significantly higher CXR severity scores and higher rates of these scores than those without abdominal obesity (P<0.001;P=0.001, respectively). While, there were no significant differences between BMI classes (P=0.104;P=0.271, respectively). Waist circumference and waist-to-height ratio (WHtR) correlated more closely with CXR severity score than BMI (r=0.43, P<0.001;r=0.41, P<0.001;r=0.17, P=0.012, respectively). The area under the curves (AUCs) for waist circumference and WHtR were significantly higher than those for BMI for distinguishing a high CXR severity score (≥8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P=0.001). Multivariable analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P<0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P=0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P<0.001) as the only independent predictors of a high CXR severity score. ConclusionAbdominal obesity might predict a high CXR severity score better than general obesity in hospitalized patients with COVID-19. Therefore, when performing clinical hospital practices, waist circumference should be assessed, and patients with abdominal obesity should be monitored closely when hospitalized.