Abstract
In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a wide spectrum of presentations, from seemingly mild asymptomatic disease to severe acute respiratory failure requiring ventilatory support with accompanying multi-organ involvement [1]
The risk of acute sarcopenia and possible cachexia should be highest in older patients with coronavirus disease 2019 (COVID-19) [6, 7]
Even if the precise and intricated mechanisms are still in exploration, many physiological phenomena have been proposed to explain the immune response remodeling over time, including chronic exposure to antigens, impaired telomerase activity, mitochondrial dysfunction, defective autophagy, endoplasmic reticulum stress, Fig. 1 Main physiopathological mechanisms involved in the development of post-covid sarcopenia defective ubiquitin–proteasome system, and age-related changes in the composition of gut microbiota [21]
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with a wide spectrum of presentations, from seemingly mild asymptomatic disease to severe acute respiratory failure requiring ventilatory support with accompanying multi-organ involvement [1]. Sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration [15] This may include both pathological changes in organ systems and functional deterioration in patients exemplified by the inability to cope with the daily life tasks or development of the psychologic disturbances [16]. Even if the precise and intricated mechanisms are still in exploration, many physiological phenomena have been proposed to explain the immune response remodeling over time, including chronic exposure to antigens, impaired telomerase activity, mitochondrial dysfunction, defective autophagy, endoplasmic reticulum stress, Fig. 1 Main physiopathological mechanisms involved in the development of post-covid sarcopenia defective ubiquitin–proteasome system, and age-related changes in the composition of gut microbiota [21]. In older subjects, the high level of inflammatory factors, as observed in COVID-19, may influence the acute changes in the body build, especially the amount, structure, and function of skeletal muscles which would summarily amount to sarcopenia [37]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
