Skeletal Muscle Manifestations and Creatine Kinase in COVID-19

Abstract

Background and Purpose Skeletal muscle symptoms and elevated creatine kinase (CK) levels have been consistently reported as part of the COVID-19 disease process. Previous studies have yet to show a consistent relationship between CK levels and skeletal muscle symptoms, disease severity, and death from COVID-19. The purpose of this study is to determine whether elevated CK is associated with a COVID-19 course requiring intubation, intensive care, and/or causing death. Secondary objectives: To determine if there is a relationship between elevated CK and (1) skeletal muscle symptoms/signs (2) complications of COVID-19 and (3) other diagnostic laboratory values. Methods This is a retrospective, single center cohort study. Data were collected from March 13, 2020, to May 13, 2020. This study included 289 hospitalized patients with laboratory-confirmed SARS-CoV-2 and measured CK levels during admission. Results Of 289 patients (mean age 68.5 [SD 13.8] years, 145 [50.2%] were men, 262 [90.7%] were African American) with COVID-19, 52 (18.0%) reported myalgia, 92 (31.8%) reported subjective weakness, and 132 (45.7%) had elevated CK levels (defined as greater than 220 U/L). Elevated CK was found to be associated with severity of disease, even when adjusting for inflammatory marker C-reactive protein (initial CK: OR 1.006 [95% CI: 1.002-1.011]; peak CK: OR 1.006 [95% CI: 1.002-1.01]; last CK: 1.009 [95% CI: 1.002-1.016]; q = .04). Creatine kinase was not found to be associated with skeletal muscle symptoms/signs or with other laboratory markers. Conclusions Creatine kinase is of possible clinical significance and may be used as an additional data point in predicting the trajectory of the COVID-19 disease process.

Machine learning versus multivariate logistic regression for predicting severe COVID‐19 in hospitalized children with Omicron variant infection

“…Muscle pain and fatigue are common manifestations of patients with COVID‐19 infection, and increased CK may predict a worse COVID‐19 outcome 39 . Similar to other published studies, 40,41 we found that the CK value for patients with severe COVID‐19 was higher than patients with mild disease.…”

“…Muscle pain and fatigue are common manifestations of patients with COVID-19 infection, and increased CK may predict a worse COVID-19 outcome. 39 Similar to other published studies, 40,41…”

Risk stratification and prognosis prediction using cardiac biomarkers in COVID-19: a single-centre retrospective cohort study

“…Contrary to the low incidence of cardiovascular complications, we frequently observed COVID-19 patients with elevated cardiac biomarkers: hsTnI≥99% ile in 24.6%, NT-proBNP≥125 pg/mL in 35.7%, CK>UNL in 25.9% and CK-MB>UNL in 11.8%. Former reports indicated similar rates of COVID-19 patients with elevated biomarker values: troponin, 6.5%–36%, BNP or NT-proBNP, 13%–49%, CK, 12%–46% and CKMB, 5.1%–11% 4–6 16 17. Consistent with the current study, patients with elevated cardiac biomarkers had a significantly higher incidence of mortality than those without cardiac biomarker elevation.…”

Skeletal muscle injury in COVID infection: Frequency and patterns

“…We did not find an association between skeletal muscle injury and severity of COVID‐19. Other authors have also reported such a lack of association 1,20–22 …”

“…Other authors have also reported such a lack of association. 1,[20][21][22] Demonstrable muscle weakness, particularly of neck flexor muscles, and disability that limits daily activities were common. Very few studies have documented formal evaluation of muscle weakness in acute settings and none exist for acute COVID infections.…”