Abstract
Backgroundacute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients.Methodscross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality.Resultstwo hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 – 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004).Discussionwe described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.
Highlights
Sarcopenia is a progressive and generalized skeletal muscle disorder, characterized by an accelerated loss of muscle mass and function, which is associated with an increased likelihood of developing adverse outcomes [1–6]
We found that one month after hospital discharge, COVID-19 survivors with reduced muscle function displayed low muscle mass and increased muscle stiffness at the ultrasound evaluation of the dominant medial gastrocnemius as compared with those with normal muscle function
We detected a significant correlation between muscle ultrasound parameters and age, nutritional status and muscle performance
Summary
Sarcopenia is a progressive and generalized skeletal muscle disorder, characterized by an accelerated loss of muscle mass and function, which is associated with an increased likelihood of developing adverse outcomes [1–6]. Muscle quality, which is precociously impaired in sarcopenia [2], has an important impact on muscle function [8] and clinical outcomes [9], independently from muscle mass reduction. Magnetic resonance imaging (MRI) and computed tomography (CT) have been used to study muscle quality, by assessing fat infiltration into muscle, and evaluating muscle attenuation [11, 12]. Muscle quality has been defined in functional terms, as the muscle strength delivered per unit of muscle mass [13, 14] or volume [15]. Because of its effects on muscle performance and clinical outcomes, muscle quality should always be considered in the assessment of sarcopenic subjects. There has not been universal consensus yet on which method should be used for the evaluation of muscle quality in the routine clinical practice [1]
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