Abstract
BackgroundMuscular fatigue and injury are frequently observed in critically ill COVID-19 patients. The aim of this study was to determine whether different muscle adipose tissue depots are associated with mortality and muscle damage in patients affected by COVID-19 admitted to the ICU.MethodsCT images were obtained in 153 ICU patients with COVID-19 (121 males and 32 females). Height, weight, body mass index (BMI), C-reactive protein, Creatine PhosphoKinase (CPK), muscle density, and intermuscular adipose tissue (IMAT) were measured.ResultsParticipants in the highest tertile of IMAT/muscle had the shorter 28-day survival from ICU admission as compared to subjects in the first tertile. Estimates derived from the Cox proportional hazard models, after adjustment for age, sex, and BMI, confirmed the results of the survival analysis (HR 3.94, 95% CI: 1.03–15.09). Participants in the lowest tertile of muscle density had the shorter survival at 28 days from ICU admission as compared to subjects in the highest tertile (HR 3.27, 95% CI: 1.18–4.61), but the relationship was no longer significant when age was included in the model. Subjects in the second muscle density tertile did not show an increased risk.Participants in the highest tertile of IMAT/muscle and those in the lowest tertile of muscle density showed both significantly higher CPK adjusted for weight values as evaluated during the first 8 days of hospitalization.ConclusionOur data seem to suggest that higher levels of IMAT/muscle and low muscle density are both associated with higher risk of ICU mortality and muscle injury as evaluated with CPK level.
Highlights
Significant deficits in upper and lower limb strength have been observed in patients with COVID-19, resulting in slow functional recovery after the hospitalization period
COVID-19 associated myopathy with severe proximal and bulbar weakness is characterized by elevated levels of IL-6 and Creatine PhosphoKinase (CPK) and the histological features of COVID-19 are mostly anecdotic and only a few case reports have been recently published on this subject
Intramuscular fat accumulation resulting in low muscle density is associated with aging, insulin resistance, and sedentary lifestyle, whilst intermuscular adipose tissue (IMAT) has been observed in patients with excess total adiposity and metabolic syndrome
Summary
Significant deficits in upper and lower limb strength have been observed in patients with COVID-19, resulting in slow functional recovery after the hospitalization period. COVID-19 associated myopathy with severe proximal and bulbar weakness is characterized by elevated levels of IL-6 and Creatine PhosphoKinase (CPK) and the histological features of COVID-19 are mostly anecdotic and only a few case reports have been recently published on this subject In these patients, examined muscles show perivascular inflammatory infiltration with endomysial extension and regenerating fibers (Zhang et al, 2020). Intramuscular fat accumulation resulting in low muscle density is associated with aging, insulin resistance, and sedentary lifestyle, whilst IMAT has been observed in patients with excess total adiposity and metabolic syndrome Both kinds of fat depots are metabolically active tissues, able to secrete inflammatory cytokines and contribute to muscle damage (Beasley et al, 2009; Zamboni et al, 2019). The aim of this study was to determine whether different muscle adipose tissue depots are associated with mortality and muscle damage in patients affected by COVID-19 admitted to the ICU
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