Longitudinal Analysis of Quadriceps Muscle Strength in Patients with Previous COVID-19 Hospitalization and in Patients with Post-Acute Sequelae following Mild COVID-19

Abstract

Muscle weakness is a prominent symptom in post-acute sequelae of COVID-19 (PASC). However, few studies have objectively and longitudinally assessed muscle strength after varying COVID-19 severity grades. This observational study aimed to explore the prevalence, determinants, and 1.5 years change of quadriceps muscle weakness in 98 patients discharged from COVID-19 hospitalization and in 50 patients with PASC following mild COVID-19. Isometric quadriceps maximal voluntary contraction (MVC) was assessed on a computerized dynamometer at three visits. Also, in a subgroup of 14 post-COVID-19 patients with quadriceps muscle weakness, muscle thickness and echo intensity were determined by muscle ultrasound of nine upper and lower extremity muscles. Muscle weakness was found in 59% of post-hospitalized patients and in 65% of those with PASC following mild COVID-19 at ~14 weeks after acute COVID-19. Whereas during ~1.5 years follow-up MVC modestly improved, muscle weakness prevalence remained unchanged. Hospital length of stay and diabetes mellitus were identified as possible predictors of muscle weakness following COVID-19 hospitalization. No predictors could be identified in those with PASC following mild COVID-19. Ultrasound outcomes revealed no large structural abnormalities. In conclusion, clinically relevant muscle weakness is common after COVID-19 and its long-term improvement is poor. Future studies with relevant control groups are warranted to confirm our data.

Exploring risk factors for persistent neurocognitive sequelae after hospitalization for COVID‐19

“…We observed a longer length of hospitalization among those with [18 (7, 29.5) days] compared to those without [7 (5,19) days] persistent neurocognitive symptoms. Hospital stay length has been identified in other studies as a risk factor for PASC 7,24,25 . Similarly, the need for intubation and history of in‐hospital delirium were more commonly observed in those that developed neuro‐PASC and each was separately associated with over five times increased odds of neuro‐PASC in our univariate models.…”

“…Hospital stay length has been identified in other studies as a risk factor for PASC. 7 , 24 , 25 Similarly, the need for intubation and history of in‐hospital delirium were more commonly observed in those that developed neuro‐PASC and each was separately associated with over five times increased odds of neuro‐PASC in our univariate models. In agreement with our findings, intubation and in‐hospital delirium has also been previously reported as risk factors for developing neuro‐PASC.…”

Long COVID: Clinical characteristics, proposed pathogenesis and potential therapeutic targets

“…Female sex and corticosteroid use during acute illness have also been associated with muscle weakness up to 1 year after infection ( Huang et al, 2021a ). Muscle weakness has been described in those with a mild initial illness ( Stoffels et al, 2022 ), but whether this reflects more than just deconditioning or muscle disuse has not been determined. The underlying cause and pathogenesis of muscle weakness is poorly understood, with viral myositis, ongoing inflammation, and deconditioning all being proposed.…”