Abstract
Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy’s “first wave” was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on “severe” (n = 99) or “mild” (n = 232) outcomes. “Severe” disease is defined here as death and/or mechanical invasive ventilation, in contrast to “mild” patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10–1672 U/L, versus median, 82; range, 12–1499 U/L, p = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a “severe” outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both “severe” and “mild” patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified.
Highlights
Several neurological and neuromuscular symptoms have been identified as part of the COVID-19 spectrum, including muscle pain and fatigue. [1] Early reports from Asia, discussed elsewhere, [2] have suggested that increased serum levels of the muscular enzyme creatine-kinase (CK or CPK) could be linked with a worse prognosis.This observation has been further confirmed by most recent retrospective studies [3] and systematic reviews [4,5]
(“severe” disease is defined here as death and/or mechanical invasive ventilation, in contrast to “mild” patients, who were discharged alive with no need for invasive ventilation; this latter group could include those patients who were treated with non-invasive ventilation), (2) the CK levels evaluated at admission with standard methods, and expressed both as a continuous variable (U/L) and as a dichotomic variable
We subdivided our cohort in two groups of “severe” and “mild” COVID-19 patients
Summary
[1] Early reports from Asia, discussed elsewhere, [2] have suggested that increased serum levels of the muscular enzyme creatine (phospho)-kinase (CK or CPK) could be linked with a worse prognosis. This observation has been further confirmed by most recent retrospective studies [3] and systematic reviews [4,5]. Even if some association between CK levels and the clinical outcomes of patients infected by SARS-CoV-2 seems to exist, the precise mechanisms are still unknown It is not known if this observed relationship is true or if it is merely a spurious association caused by other clinical or demographic factors. The aim of this retrospective cohort study was to confirm (or exclude) this relationship in a Caucasian population, and to evaluate the role of possible confounding factors such as age, body mass index (BMI), gender and associated disorders
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