COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer

Abstract

Background The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. Main body The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). Conclusion Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.

Non-Respiratory Symptoms of Patients Infected with SARS-CoV-2 (Coronavirus Disease 2019): Lessons from Their Initial Presentation at the Hospital

“…Fatigue is a common symptom in those presenting with COVID-19 infection with listed rates between 16.6% and 75% [6,11,12]. Studies have described extensive muscle dysfunction in SARS patients, while widespread muscle fiber atrophy, fiber necrosis and myofibril disarray were demonstrated in post-mortem muscle tissue of patients with SARS [4,13]. SARS-CoV-2 infection can also cause neuronal demyelination, which may further lead to additional generalized muscle weakness and fatigue [4].…”

Obesity and the Frailty Syndrome at Period of Covid-19

“…CoV-2 (Severe Acute Respiratory Syndrome Coronavirus) are not understood. It is possible to ignore the potential of COVID-19 to induce chronic disease, sarcopenia, and physical functional decline and go beyond the expected respiratory consequences [17]. In fact, in COVID-19 patients, the cytokine system is considered to have a short life expectancy due to a higher inflammatory response [18].…”

A pandemic of acute respiratory distress syndrome—role of lung transplant in coronavirus disease-2019–associated respiratory failure

“…Frailty can have serious consequences in lung transplant surgery. It is associated with greater risk for prolonged postoperative respiratory failure and mortality [ 25 ]. Multi-organ failure COVID-19 is a multi-system disorder that can potentially have short-term and long-term sequelae.…”