Intermuscular Adipose Tissue as a Risk Factor for Mortality and Muscle Injury in Critically Ill Patients Affected by COVID-19

Abstract

BackgroundMuscular fatigue and injury are frequently observed in critically ill COVID-19 patients. The aim of this study was to determine whether different muscle adipose tissue depots are associated with mortality and muscle damage in patients affected by COVID-19 admitted to the ICU.MethodsCT images were obtained in 153 ICU patients with COVID-19 (121 males and 32 females). Height, weight, body mass index (BMI), C-reactive protein, Creatine PhosphoKinase (CPK), muscle density, and intermuscular adipose tissue (IMAT) were measured.ResultsParticipants in the highest tertile of IMAT/muscle had the shorter 28-day survival from ICU admission as compared to subjects in the first tertile. Estimates derived from the Cox proportional hazard models, after adjustment for age, sex, and BMI, confirmed the results of the survival analysis (HR 3.94, 95% CI: 1.03–15.09). Participants in the lowest tertile of muscle density had the shorter survival at 28 days from ICU admission as compared to subjects in the highest tertile (HR 3.27, 95% CI: 1.18–4.61), but the relationship was no longer significant when age was included in the model. Subjects in the second muscle density tertile did not show an increased risk.Participants in the highest tertile of IMAT/muscle and those in the lowest tertile of muscle density showed both significantly higher CPK adjusted for weight values as evaluated during the first 8 days of hospitalization.ConclusionOur data seem to suggest that higher levels of IMAT/muscle and low muscle density are both associated with higher risk of ICU mortality and muscle injury as evaluated with CPK level.

Function Over Mass: A Meta-Analysis on the Importance of Skeletal Muscle Quality in COVID-19 Patients

“…All studies employed the real-time polymerase chain reaction (RT-PCR) test to confirm SARS-CoV-2 infection. Of the 7 studies included in the analysis, 2 were carried out in Turkey ( 26 , 28 ), 2 in China ( 29 , 30 ), 1 in Italy ( 27 ), 1 in the Netherlands ( 20 ) and 1 in Brazil ( 18 ). The sample size of the studies ranged from 100 to 234 patients.…”

Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience

“…Although the motor symptomatology is less frequent than other neurological symptoms in COVID-19 illness, some symptoms were detected, such as the neuropathic pain ( McWilliam et al, 2021 ), ataxia, skeletal muscular injury and myopathic changes, especially in critical patients associated to the long recovery in-hospital stay or ICU stay ( Liu et al, 2020 ; Mao et al, 2020 ; Rossi et al, 2021 ; Villa et al, 2021 ). The literature also report neurological motor syndromes such as the Guillain-Barre Syndrome (GBS) ( Ellul et al, 2020 ).…”

“…Besides, in Spain there is reported 1 in 847 in the Spanish registry ALBACOVID of Castilla La Mancha ( Romero-Sánchez et al, 2020 ). The cited motor symptoms together with the loss of muscle density are associated with higher risk of mortality, especially in ICU hospitalized patients ( Rossi et al, 2021 ). Motor symptoms are usually present in ICU patients because critically ill patients present several additional risk factors for nervous system damage, which affect motor function, as they are direct viral invasion of the nervous system, systemic cytokine storm and severe hypoxemia.…”

Effect of Body Composition Change during Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

“…In recent years, muscle quality, especially intermuscular adipose tissue (IMAT), has been associated with survival [47]. Recently, IMAT has been reported as a mortality risk factor for coronavirus disease 2019 [48]. It is possible that BCC group was not associated with OS in our study since OS was associated with IMAT, rather than changes in visceral fat mass, and further study is needed to elucidate this.…”