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Barajas-Martínez A, Mehta R, Ibarra-Coronado E, Fossion R, Martínez Garcés VJ, Arellano MR, González Alvarez IA, Bautista YVM, Bello-Chavolla OY, Pedraza NR, Encinas BR, Carrión CIP, Ávila MIJ, Valladares-García JC, Vanegas-Cedillo PE, Juárez DH, Vargas-Vázquez A, Antonio-Villa NE, Almeda-Valdes P, Resendis-Antonio O, Hiriart M, Frank A, Aguilar-Salinas CA, Rivera AL. Physiological Network Is Disrupted in Severe COVID-19. Front Physiol 2022; 13:848172. [PMID: 35360235 PMCID: PMC8961032 DOI: 10.3389/fphys.2022.848172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
The human body is a complex system maintained in homeostasis thanks to the interactions between multiple physiological regulation systems. When faced with physical or biological perturbations, this system must react by keeping a balance between adaptability and robustness. The SARS-COV-2 virus infection poses an immune system challenge that tests the organism's homeostatic response. Notably, the elderly and men are particularly vulnerable to severe disease, poor outcomes, and death. Mexico seems to have more infected young men than anywhere else. The goal of this study is to determine the differences in the relationships that link physiological variables that characterize the elderly and men, and those that characterize fatal outcomes in young men. To accomplish this, we examined a database of patients with moderate to severe COVID-19 (471 men and 277 women) registered at the "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán" in March 2020. The sample was stratified by outcome, age, and sex. Physiological networks were built using 67 physiological variables (vital signs, anthropometric, hematic, biochemical, and tomographic variables) recorded upon hospital admission. Individual variables and system behavior were examined by descriptive statistics, differences between groups, principal component analysis, and network analysis. We show how topological network properties, particularly clustering coefficient, become disrupted in disease. Finally, anthropometric, metabolic, inflammatory, and pulmonary cluster interaction characterize the deceased young male group.
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Affiliation(s)
- Antonio Barajas-Martínez
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | | | - Ruben Fossion
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Vania J. Martínez Garcés
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Monserrat Ramírez Arellano
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | | | | | - Natalia Ramírez Pedraza
- Departamento de Radiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Bethsabel Rodríguez Encinas
- Departamento de Radiología, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Carolina Isabel Pérez Carrión
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - María Isabel Jasso Ávila
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Jorge Carlos Valladares-García
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Pablo Esteban Vanegas-Cedillo
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Diana Hernández Juárez
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Arsenio Vargas-Vázquez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Neftali Eduardo Antonio-Villa
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Plan of Combined Studies in Medicine (PECEM-MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Osbaldo Resendis-Antonio
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto Nacional de Medicina Genómica & Coordinación de la Investigación Científica-Red de Apoyo a la Investigación, UNAM, Ciudad de México, Mexico
| | - Marcia Hiriart
- Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Alejandro Frank
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- El Colegio Nacional, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Ciudad de México, Mexico
| | - Ana Leonor Rivera
- Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
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Vanegas-Cedillo PE, Bello-Chavolla OY, Ramírez-Pedraza N, Rodríguez Encinas B, Pérez Carrión CI, Jasso-Ávila MI, Valladares-García JC, Hernández-Juárez D, Vargas-Vázquez A, Antonio-Villa NE, Chapa-Ibarguengoitia M, Ponce de Leon A, Sifuentes-Osornio J, Aguilar-Salinas CA, Mehta R. Serum Vitamin D Levels Are Associated With Increased COVID-19 Severity and Mortality Independent of Whole-Body and Visceral Adiposity. Front Nutr 2022; 9:813485. [PMID: 35155539 PMCID: PMC8825804 DOI: 10.3389/fnut.2022.813485] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/04/2022] [Indexed: 01/08/2023] Open
Abstract
IntroductionCoronavirus disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with susceptibility to infectious disease. In this study, the association between COVID-19 outcomes and vitamin D levels in patients attending a COVID-19 reference center in Mexico City are examined.MethodsConsecutive patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation and follow-up, laboratory measurements and a thoracic computerized tomography, including the measurement of epicardial fat thickness. Low vitamin D was defined as levels <20 ng/ml (<50nmol/L) and deficient Vitamin D as a level ≤12 ng/ml (<30 nmol/L).ResultsOf the 551 patients included, low vitamin D levels were present in 45.6% and deficient levels in 10.9%. Deficient Vitamin D levels were associated with mortality (HR 2.11, 95%CI 1.24–3.58, p = 0.006) but not with critical COVID-19, adjusted for age, sex, body-mass index and epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 mortality conferred by low vitamin D levels was partly mediated by its effect on D-dimer and cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by low vitamin D levels was independent of BMI and epicardial fat.ConclusionVitamin D deficiency (≤12 ng/ml or <30 nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.
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Affiliation(s)
- Pablo Esteban Vanegas-Cedillo
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Omar Yaxmehen Bello-Chavolla
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Natalia Ramírez-Pedraza
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Bethsabel Rodríguez Encinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carolina Isabel Pérez Carrión
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Isabel Jasso-Ávila
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Carlos Valladares-García
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana Hernández-Juárez
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Monica Chapa-Ibarguengoitia
- Department of Radiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce de Leon
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Internal Medicine Division, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Mexico City, Mexico
| | - Carlos A. Aguilar-Salinas
- Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Mexico City, Mexico
- Division of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- *Correspondence: Roopa Mehta
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Mehta R, Bello-Chavolla OY, Mancillas-Adame L, Rodriguez-Flores M, Pedraza NR, Encinas BR, Carrión CIP, Ávila MIJ, Valladares-García JC, Vanegas-Cedillo PE, Juárez DH, Vargas-Vázquez A, Antonio-Villa NE, Chapa-Ibarguengoitia M, Almeda-Valdés P, Elias-Lopez D, Galindo-Fraga A, Gulias-Herrero A, de Leon AP, Sifuentes-Osornio J, Aguilar-Salinas CA. Epicardial adipose tissue thickness is associated with increased COVID-19 severity and mortality. Int J Obes (Lond) 2022; 46:866-873. [PMID: 35017712 PMCID: PMC8749108 DOI: 10.1038/s41366-021-01050-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
Background Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. Methods We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. Results EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01–1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67–28.0%) and 5.1% (95% CI 0.19–14.0%) of the effect of age and 19.4% (95% CI 4.67–63.0%) and 12.8% (95% CI 0.03–46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. Conclusion EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.
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Affiliation(s)
- Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico. .,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico.
| | | | | | | | | | | | | | | | | | | | | | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,MD/PhD (PECEM) program, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Paloma Almeda-Valdés
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico
| | - Daniel Elias-Lopez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico.,Department of Endocrinology and Metabolism, INCMNSZ, Mexico City, Mexico
| | | | | | | | - José Sifuentes-Osornio
- Department of Infectology, INCMNSZ, Mexico City, Mexico.,Internal Medicine Division, Albuquerque, NM, USA
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico. .,Instituto Tecnologico y de Estudios Superiores de Monterrey Tec Salud, Monterrey, Mexico. .,Division of Nutrition, INCMNSZ, Mexico City, Mexico.
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