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             <jats:title>Background<\/jats:title>\n                    <jats:p>Chest computed tomography (CT) is a valuable tool for diagnosing and predicting the severity of coronavirus disease 2019 (COVID\u201019) and assessing extrapulmonary organs. Reduced muscle mass and visceral fat accumulation are important features of a body composition phenotype in which obesity and muscle loss coexist, but their relationship with COVID\u201019 outcomes remains unclear. In this study, we aimed to investigate the association between the erector spinae muscle (ESM) to epicardial adipose tissue (EAT) ratio (ESM\/EAT) on chest CT and disease severity in patients with COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 1074 COVID\u201019 patients enrolled in the Japan COVID\u201019 Task Force database. The primary outcome was the rate of critical outcomes (requiring high\u2010flow oxygen therapy, invasive ventilator support or death). The incidence of critical outcomes was compared between patients with high and low ESM\/EAT ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The low ESM\/EAT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009353) had a higher incidence of critical outcomes (13.3% vs. 5.13%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and mortality (2.55% vs. 0.69%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) than the high ESM\/EAT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009721). In multivariable analysis, the low ESM\/EAT ratio was associated with critical outcomes (adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.22\u20133.66) independently of the known COVID\u201019 severity factors including age, sex, body mass index (BMI), smoking history, lifestyle\u2010related comorbidities and pneumonia volume.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The low ESM\/EAT ratio in COVID\u201019 patients can be obtained on chest CT and used to predict critical outcomes after disease onset, demonstrating the importance of detailed body composition assessments in COVID\u201019 practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.13721","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T06:36:59Z","timestamp":1737959819000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Erector Spinae Muscle to Epicardial Visceral Fat Ratio on Chest CT Predicts the Severity of Coronavirus Disease 2019"],"prefix":"10.1002","volume":"16","author":[{"given":"Takashi","family":"Shimada","sequence":"first","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Medicine Keio University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Maetani","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Graduate School of Medicine Kyoto University  Kyoto 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