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Observational Study
. 2021 Jan;37(1):e3354.
doi: 10.1002/dmrr.3354. Epub 2020 Jun 14.

Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID-19: A multicentric prospective evaluation

Stefano Di Bella  1 , Roberto Cesareo  2 , Paolo De Cristofaro  3 , Andrea Palermo  4 , Gianfranco Sanson  5 , Erik Roman-Pognuz  6 , Verena Zerbato  7 , Silvia Manfrini  4 , Donatella Giacomazzi  8 , Eugenia Dal Bo  8 , Gianluca Sambataro  9 , Elisabetta Macchini  6 , Francesco Quintavalle  6 , Giuseppe Campagna  10 , Renato Masala  10 , Luigi Ottaviani  10 , Cosmo Del Borgo  11 , Lorenzo Ridola  12 , Frida Leonetti  13 , Giorgio Berlot  6 , Roberto Luzzati  1
Affiliations
Observational Study

Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID-19: A multicentric prospective evaluation

Stefano Di Bella et al. Diabetes Metab Res Rev. 2021 Jan.

Abstract

Aims: COVID-19 is especially severe for elderly subjects with cardiometabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients.

Materials and methods: We prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from 25 March to 7 April 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission.

Results: We enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260-per 1 cm increase 95% CI:1.120-1.417; P < .001), with a stronger association in the subgroup with BMI ≤30 Kg/m2 (adjusted OR 1.526; 95% CI:1.243-1.874; P < .001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < .001). In particular, NC > 40.5 cm (>37.5 for females and >42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test: P < .001).

Conclusions: NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.

Keywords: BMI; COVID-19; invasive mechanical ventilation; neck circumference; obesity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Differences in neck circumference according to the highest level of respiratory support provided during the observation time for general population and for male or female patients, both in the whole study population and after excluding patients with a BMI of >30 kg/m2
FIGURE 2
FIGURE 2
ROC curves for all tested subgroups
FIGURE 3
FIGURE 3
Kaplan‐Meier curves for the risk of IMV in patients belonging to the NC groups according to the identified risk threshold and to patient's sex. IMV, invasive mechanical ventilation; NC, neck circumference
See this image and copyright information in PMC

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