Skeletal Muscle Wasting and Function Impairment in Intensive Care Patients With Severe COVID-19

Abstract

Background: Intensive care patients commonly develop muscle wasting and functional impairment. However, the role of severe COVID-19 in the magnitude of muscle wasting and functionality in the acute critical disease is unknown.Objective: To perform a prospective characterization to evaluate the skeletal muscle mass and functional performance in intensive care patients with severe COVID-19.Methods: Thirty-two critically ill patients (93.8% male; age: 64.1 ± 12.6 years) with the diagnosis of the severe COVID-19 were prospectively recruited within 24 to 72 h following intensive care unit (ICU) admission, from April 2020 to October 2020, at Hospital Sírio-Libanês in Brazil. Patients were recruited if older than 18 years old, diagnosis of severe COVID-19 confirmed by RT-PCR, ICU stay and absence of limb amputation. Muscle wasting was determined through an ultrasound measurement of the rectus femoris cross-sectional area, the thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius), and echogenicity. The peripheral muscle strength was assessed with a handgrip test. The functionality parameter was determined through the ICU mobility scale (IMS) and the International Classification of Functioning, Disability and Health (ICF). All evaluations were performed on days 1 and 10.Results: There were significant reductions in the rectus femoris cross-section area (−30.1% [95% IC, −26.0% to −34.1%]; P < 0.05), thickness of the anterior compartment of the quadriceps muscle (−18.6% [95% IC, −14.6% to 22.5%]; P < 0.05) and handgrip strength (−22.3% [95% IC, 4.7% to 39.9%]; P < 0.05) from days 1 to 10. Patients showed increased mobility (0 [0–5] vs 4.5 [0–8]; P < 0.05), improvement in respiratory function (3 [3–3] vs 2 [1–3]; P < 0.05) and structure respiratory system (3 [3–3] vs 2 [1–3]; P < 0.05), but none of the patients returned to normal levels.Conclusion: In intensive care patients with severe COVID-19, muscle wasting and decreased muscle strength occurred early and rapidly during 10 days of ICU stay with improved mobility and respiratory functions, although they remained below normal levels. These findings may provide insights into skeletal muscle wasting and function in patients with severe COVID-19.

The Predictive Value of Myoglobin for COVID-19-Related Adverse Outcomes: A Systematic Review and Meta-Analysis

“…The mechanistic link between Mb and COVID-19 prognosis is unclear, but it may be the distribution of Mb in skeletal muscle besides myocardium, making it more sensitive to the dynamics of systemic states ( 36 ). de Andrade-Junior et al reported that patients with severe COVID-19 are prone to develop muscle wasting and impaired muscle function ( 37 ). Moreover, Mb can be rapidly released into the blood in response to inflammatory stimuli ( 38 ).…”

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…In patients with severe COVID-19 infections, hyperinflammation and immobilization lead to muscle volume loss with 30.1% during 10 days of ICU stay [99]. Furthermore, malnutrition, based on the Global Leadership Initiative on Malnutrition, was observed at a frequency of 18% at ICU admission, 79% at ICU discharge, and 53% at 3 months after ICU discharge [100].…”

Neuromuscular Electrical Stimulation in Patients With Severe COVID-19 Associated With Sepsis and Septic Shock

“…Muscle mass was assessed using ultrasonography. Patients were evaluated concerning rectus femoris cross-sectional area (cm 2 ), the thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius) (cm), and rectus femoris echogenicity (pixels) ( 5 ). The transducer was positioned perpendicular to the longitudinal axis of the thigh in 80% of the distal distance between the anterosuperior iliac spine and the upper midpoint of the patella to obtain measurements of the rectus femoris cross-sectional area, and thickness of the anterior compartment of the quadriceps muscle (rectus femoris and vastus intermedius).…”

“…Functionality was assessed by the International Classification of Functioning, Disability, and Health (ICF) using the muscle strength domains (b730) based on the Medical Research Council (MRC) score for global strength ( 5 ). The ICF scores used were: 0–58 to 60 (without significant changes); 1–48 to 57 (slight loss); 2–31 to 47 (moderate loss); 3–4 to 30 (severe loss); and 4–0 to 3 (maximum loss).…”

“…Most patients have a mild form of the disease, but 5% of patients present severe lung injury and required intensive care ( 4 ). These patients may develop ICU-acquired weakness ( 5 ).…”