Association of Paraspinal Muscle Measurements on Chest Computed Tomography With Clinical Outcomes in Patients With Severe Coronavirus Disease 2019

Abstract

Background Skeletal muscle depletion is common in the elderly and individuals with chronic comorbidities, who have an increased risk of developing severe coronavirus disease 2019 (COVID-19), which is defined by hypoxia requiring supplemental oxygen. This study aimed to determine the association between skeletal muscle depletion and clinical outcomes in patients with severe COVID-19. Methods One hundred and sixteen patients with severe COVID-19 who underwent chest computed tomography (CT) scan on admission were included in this multicentre, retrospective study. Paraspinal muscle index (PMI) and radiodensity (PMD) were measured using CT images. The primary composite outcome was the occurrence of critical illness (respiratory failure requiring mechanical ventilation, shock, or intensive care unit admission) or death, and the secondary outcomes were the duration of viral shedding and pulmonary fibrosis in the early rehabilitation phase. Logistic regression and Cox proportional hazards models were employed to evaluate the associations. Results The primary composite outcome occurred in 48 (41.4%) patients, who were older and had lower PMD (both P < 0.05). Higher PMD was associated with reduced risk of critical illness or death in a fully adjusted model overall (OR per SD increment: 0.87, 95% CI: 0.80-0.95; P = 0.002) and in female patients (OR per SD increment: 0.71, 95% CI: 0.56-0.91; P = 0.006), although the effect was not statistically significant in male patients (P = 0.202). Higher PMD (HR per SD increment: 1.08, 95% CI: 1.02-1.14; P = 0.008) was associated with shorter duration of viral shedding among female survivors. However, no significant association was found between PMD and pulmonary fibrosis in the early rehabilitation phase, or between PMI and any outcome in both men and women. Conclusion Higher PMD, a proxy measure of lower muscle fat deposition, was associated with a reduced risk of disease deterioration and decreased likelihood of prolonged viral shedding among female patients with severe COVID-19.

The Effect of the Vitamin D Level on the Clinical, Laboratory, and Outcome in Patients Over 65 Years of Age With Covid-19: Comprehensive Tertiary Center Experience

“…The median age was 74 (68-79) years, and the median BMI was 22.4 kg/m 2 (20.5-24.5). Among the participants, 93.8% (122) had at least one comorbidity, and the most common comorbidities were type 2 diabetes mellitus, hypertension, and chronic obstructive pulmonary disease, with a prevalence of 23.8% (31), 26% (20), and 16.9% (22), respectively. The median time from the onset of symptoms at admission was 6 days (4-8), median body temperature was 37.4°C (36.8-38.6), and median oxygen saturation on room air was 88% (86-89).…”

Skeletal muscle depletion predicts death in severe community-acquired pneumonia patients entering ICU

“…8,[25][26][27][28] Skeletal muscle, particularly intramuscular fat, which is the main active substance, can participate in immune response by releasing cytokines. 13,29 A study revealed that IL-15 levels in serum are inversely proportional to age and exert immune function by promoting muscle cell development and reducing fat infiltration, which can partially explain why reduced skeletal muscle mass causes immune dysfunction. 30,31 In other words, skeletal muscle mass reduction is associated with increased intramuscular fat, which is more likely to release numerous cytokines, leading to systemic inflammation, thereby aggravating the disease.…”

“…By limiting unit thresholds of À29 to +150, skeletal muscles were distinguished from surrounding tissues, implying that skeletal muscles could be selected in the designated area. 13,19,20 PMA was defined as any muscle behind the spine and the 12th rib, and paraspinal muscle radiodensity (PMD) was the average density of the area, as depicted in Fig. 2.…”

“…8,9 As digital imaging develops, CT imaging of psoas area, paravertebral, appendix, and paraspinal muscle has become a reliable methodology for diagnosing sarcopenia. [10][11][12][13] The area of the psoas muscle was the most commonly used indicator for skeletal muscle mass. 10,14 However, chest CT routinely performed by patients with pneumonia excludes this area.…”

“…Some studies have confirmed that PMA on transverse CT images at the 12th thoracic levels is a good predictor for COVID-19 and other lung diseases. 13,[15][16][17] This study retrospectively investigated the clinical parameters, including PMA obtained from chest CT and other risk factors, to assess whether they can be utilized as death indicators during hospitalization for SCAP patients.…”