Critical illness myopathy as a consequence of Covid-19 infection

Tankisi, Hatice; Tankisi, Alp; Harbo, Thomas; Markvardsen, Lars Kjøbsted; Andersen, Henning; Pedersen, Thomas Klit

doi:10.1016/j.clinph.2020.06.003

Cited by 73 publications

(80 citation statements)

References 5 publications

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“…This is in contrast to the overall literature, which states that CIM is more common than CIN [19]. One recent case of CIM as a likely consequence of SARS-CoV2 infection was published [13], but to our knowledge no cases of CIN have yet been reported. Speculations have also been made regarding increased number of CIM patients in COVID-19 cohorts since propofol is considered a risk factor for CIM [20].…”

Section: Discussioncontrasting

confidence: 90%

“…Thus, it would be highly valuable to predict COVID-19 patients at risk of developing CIN/CIM and secondly distinguish between the two if possible. So far, only one case report of a patient with CIM has been published [13] and no reports have to our knowledge described any cases of CIN associated with COVID-19. Except for electrophysiological parameters that classify CIN or CIM, increased plasma concentration of the axonal injury marker neurofilament light (NfL) has been described elevated in patients with ICUAW [14].…”

Section: Introductionmentioning

confidence: 99%

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Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study

Frithiof

Rostami

Kumlien

et al. 2020

Preprint

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Background: Several reports on neurological complications associated with SARS-CoV-2 infection have been published. However, systematic description on intensive care unit acquired weakness (ICUAW) are still missing. Methods: The objective was to determine the incidence and characteristics of critical illness polyneuropathy (CIN) and myopathy (CIM) in patients with severe COVID-19. We also aimed to describe the electrophysiological features and their relation to plasma biomarkers for neuronal injury. This was a prospective observational intensive care unit cohort study. All adult patients admitted to the general intensive care unit (ICU) at Uppsala University Hospital, Uppsala, Sweden, between March 13 and June 8, 2020 were screened for inclusion. Patients with PCR confirmed COVID-19 were included. All patients were admitted to intensive care treatment due to severe COVID-19, including intravenous anaesthesia, opioid anaelgesia, neuromuscular blockade and mechanical ventilation. Associations of clinical, electrophysiological (sensory and motor conduction studies and electromyography) and biomarker data [neurofilament light chain (NfL), glial fibrillary acidic protein (GFAp) and tau] were studied between COVID-19 patients who developed CIN/CIM and those who did not. Results: 111 COVID-19 patients were included, 11 (11 males, mean age: 64 years) developed CIN/CIM whereas 100 (74 males, mean age: 61 years) did not (non-CIN/CIM). The CIN/CIM incidence was higher in COVID-19 patients compared to a general ICU-population treated during 2019 (9.9% vs 3.4%). In particular CIN was more frequent in the COVID-19 ICU cohort (50%) compared with the non-COVID-19 ICU cohort (0%, p=0.008). NfL and GFAp levels were higher in the CIN/CIM group both at the early (<9 days) and late time points (>11 days) compared with the non-CIN/CIM group (both p=0.001) and correlated with nerve amplitudes. Conclusions: CIN/CIM, in particular CIN, were more prevalent among COVID-19 patients than an ICU treated control cohort and should be considered in the differential diagnostic workup and the further rehabilitation of COVID-19 patients. COVID-19 patients who later developed ICUAW had significantly higher NfL and GFAp in the early phase of ICU care, which suggests their potential as predictive biomarkers. Trial registration: The study protocol was registered (ClinicalTrialsID:NCT04316884). Mechanisms for Organ Dysfunction in Covid-19 (UMODCOVID19) March 18, 2020.

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Section: Discussioncontrasting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study

Frithiof

Rostami

Kumlien

et al. 2020

Preprint

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“…of patients Mean Age of the patients(Range) Notes Symptoms related to Skeletal Muscles and Neuromuscular Junction (NMJ) 1 Skeletal muscles injury and Rhabdomyolysis 3 Articles [ 39 ], [ 58 ], [ 60 ] 38 NR in all articles. 2 Myopathy [ 60 ], [ 250 ], [ 251 ] 28 NR in all articles. 3 Myositis [ 252 ] 1 58 Y/O F 58 Y/O F with muscle biopsy suggestive of Myositis.…”

Section: Resultsmentioning

confidence: 99%

“…Major proposed risk factors for this type of myopathy are severe respiratory distress, systemic inflammatory response and sepsis. [250,251] Moreover direct invasion of the muscle by the virus is the other potential mechanism for myopathy. Similar to SARS-CoV-1, SARS-CoV-2 have the ability to penetrate the cells that express ACE2 receptors.…”

Section: Symptoms Associated With Skeletal Muscle and Neuromuscular Jmentioning

confidence: 99%

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Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Dorche

Huot

Osherov

et al. 2020

Journal of the Neurological Sciences

183

182

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Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. Methods: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. Results: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. Conclusion: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.

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Development and early diagnosis of critical illness myopathy in COVID‐19 associated acute respiratory distress syndrome

Rodríguez

Branca

Gutt-Will

et al. 2022

J cachexia sarcopenia muscle

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Background The COVID‐19 pandemic has greatly increased the incidence and clinical importance of critical illness myopathy (CIM), because it is one of the most common complications of modern intensive care medicine. Current diagnostic criteria only allow diagnosis of CIM at an advanced stage, so that patients are at risk of being overlooked, especially in early stages. To determine the frequency of CIM and to assess a recently proposed tool for early diagnosis, we have followed a cohort of COVID‐19 patients with acute respiratory distress syndrome and compared the time course of muscle excitability measurements with the definite diagnosis of CIM. Methods Adult COVID‐19 patients admitted to the Intensive Care Unit of the University Hospital Bern, Switzerland requiring mechanical ventilation were recruited and examined on Days 1, 2, 5, and 10 post‐intubation. Clinical examination, muscle excitability measurements, medication record, and laboratory analyses were performed on all study visits, and additionally nerve conduction studies, electromyography and muscle biopsy on Day 10. Muscle excitability data were compared with a cohort of 31 age‐matched healthy subjects. Diagnosis of definite CIM was made according to the current guidelines and was based on patient history, results of clinical and electrophysiological examinations as well as muscle biopsy. Results Complete data were available in 31 out of 44 recruited patients (mean [SD] age, 62.4 [9.8] years). Of these, 17 (55%) developed CIM. Muscle excitability measurements on Day 10 discriminated between patients who developed CIM and those who did not, with a diagnostic precision of 90% (AUC 0.908; 95% CI 0.799–1.000; sensitivity 1.000; specificity 0.714). On Days 1 and 2, muscle excitability parameters also discriminated between the two groups with 73% (AUC 0.734; 95% CI 0.550–0.919; sensitivity 0.562; specificity 0.857) and 82% (AUC 0.820; CI 0.652–0.903; sensitivity 0.750; specificity 0.923) diagnostic precision, respectively. All critically ill COVID‐19 patients showed signs of muscle membrane depolarization compared with healthy subjects, but in patients who developed CIM muscle membrane depolarization on Days 1, 2 and 10 was more pronounced than in patients who did not develop CIM. Conclusions This study reports a 55% prevalence of definite CIM in critically ill COVID‐19 patients. Furthermore, the results confirm that muscle excitability measurements may serve as an alternative method for CIM diagnosis and support its use as a tool for early diagnosis and monitoring the development of CIM.

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Critical illness myopathy as a consequence of Covid-19 infection

Cited by 73 publications

References 5 publications

Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study

Critical Illness Polyneuropathy and Myopathy in COVID-19 Patients: A Prospective Observational Intensive Care Unit Cross-Sectional Cohort Study

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Development and early diagnosis of critical illness myopathy in COVID‐19 associated acute respiratory distress syndrome

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