Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections.

BACKGROUND: Post-COVID-19 syndrome is characterized by diverse symptoms and abnormalities that persist beyond 12 weeks from the onset of acute COVID-19. Severity disease has been associated with more musculoskeletal alterations such as muscle weakness, dyspnea, and distance walking. The aim was to evaluate the impact of invasive mechanical ventilation (IMV) on body composition and investigate risk factors associated with sarcopenia in post-COVID-19 patients three months after moderate or severe COVID-19 infections. METHODS: Cross-sectional study. 530 patients with PCR-confirmed diagnoses of moderate to severe COVID-19, > 18 years old, oxygen saturation ≤ 93%, PaO2/FiO2 ratio < 300, who required hospitalization and were discharged were included. We excluded those who died before the follow-up visit, declined to participate, or could not be contacted. RESULTS: The mean age was 53.79 ± 12.90 years. IMV subjects had lower phase angle and handgrip strength and higher impedance index, frequency of low muscle mass, and low muscle strength than those without IMV. The risk factors of sarcopenia were > 60 years of age, diabetes, obesity, IMV, and prolonged hospital stay. The multivariate model showed that age > 60 years (OR: 4.91, 95% CI: 2.26-10.63), obesity (OR: 3.73, 95% CI: 1.21-11.54), and interaction between prolonged length of hospital stay and IMV (OR: 2.92; 95% CI: 1.21-7.02) were related to a higher risk of sarcopenia. CONCLUSION: Obesity and the interaction between prolonged length of hospital stay and IMV are associated with a higher risk of sarcopenia at 3 months after severe or moderate COVID-19 infection.

Plasma Endothelial and Oxidative Stress Biomarkers Associated with Late Mortality in Hospitalized COVID-19 Patients.

BACKGROUND: Coronavirus infectious disease 2019 (COVID-19) is a significant public health problem worldwide. COVID-19 increases the risk of non-pulmonary complications such as acute myocardial injury, renal failure, thromboembolic events, and multi-organic damage. Several studies have documented increased inflammation molecules, endothelial dysfunction biomarkers, and dysregulation of coagulation factors in COVID-19 patients. In addition, endothelium dysfunction is exacerbated by the oxidative stress (OxS) promoted by endocrine and cardiovascular molecules. Our objective was to evaluate whether endothelial and OxS biomarkers were associated with mortality in hospitalized COVID-19 patients. METHODS: A prospective cohort study was performed. Patients ≥18 years old with confirmed COVID-19 that required hospitalization were included in a prospective cohort study. Endothelium and oxidative stress biomarkers were collected between 3 and 5 days after admission. RESULTS: A total of 165 patients were evaluated; 56 patients succumbed. The median follow-up was 71 days [23-129]. Regarding endothelial dysfunction and OxS biomarkers, patients who did not survive had higher levels of nitrates (0.4564 [0.1817-0.6761] vs. 0.2817 [0.0517-0.5], p = 0.014), total nitrates (0.0507 [-0.0342-0.1809] vs. -0.0041 [-0.0887-0.0909], p = 0.016), sE-Selectin (1.095 [0.86-1.495] vs. 0.94 [0.71-1.19], p = 0.004), and malondialdehyde (MDA) (0.50 [0.26-0.72] vs. 0.36 [0.23-0.52], p = 0.010) compared to patients who survived. Endothelial and OxS biomarkers independently associated with mortality were sE-selectin (HR:2.54, CI95%; from 1.11 to 5.81, p = 0.027), nitrates (HR:4.92, CI95%; from 1.23 to 19.63, p = 0.024), and MDA (HR: 3.05, CI95%; from 1.14 to 8.15, p = 0.025). CONCLUSIONS: Endothelial dysfunction (sE-selectin and nitrates) and OxS (MDA) are independent indicators of a worse prognosis in COVID-19 patients requiring hospitalization.