Abstract
PurposeTo evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients.MethodsIn this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05).ResultsOne-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L−1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L−1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each).ConclusionsMuscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.
Highlights
Muscle loss can be investigated by various radiological techniques including dual energy absorptiometry, magnetic resonance imaging (MRI), and computed tomography (CT) [1,2,3,4,5,6]
Muscle loss seems to be a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports
Despite the utility of radiology for evaluating sarcopenia and the fact that worldwide the scientific community is looking for predictors of COVID-19 severity, to-date, imaging-based studies investigating the role of muscle composition in COVID-19 patients were still missing
Summary
Muscle loss can be investigated by various radiological techniques including dual energy absorptiometry, magnetic resonance imaging (MRI), and computed tomography (CT) [1,2,3,4,5,6]. The latter which is overall the gold standard for the evaluation of body composition allowing a distinction of different tissues according to the attenuation of the X-ray beam, has been widely used for investigating and quantifying muscle loss in the elderly and in patients who underwent prolonged hospitalization [7,8,9,10,11]. Researchers called for awareness raising about the occurrence of acute and chronic muscle loss in this group of patients and started to demand for tailored dietary and rehabilitation programs [14, 15].
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