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1.
Sci Rep ; 12(1): 6443, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1799564

ABSTRACT

As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02-1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92-3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45-0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.


Subject(s)
COVID-19 , Sarcopenia , Abdomen , Body Composition , COVID-19/diagnosis , COVID-19/diagnostic imaging , Humans , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Retrospective Studies , SARS-CoV-2 , Sarcopenia/diagnostic imaging , Sarcopenia/pathology , Tomography, X-Ray Computed
2.
Front Endocrinol (Lausanne) ; 13: 801133, 2022.
Article in English | MEDLINE | ID: covidwho-1731766

ABSTRACT

BACKGROUND: acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients. METHODS: cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality. RESULTS: two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004). DISCUSSION: we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.


Subject(s)
COVID-19/epidemiology , Muscle Strength/physiology , Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Survivors , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/pathology , Cross-Sectional Studies , Extremities/diagnostic imaging , Extremities/physiopathology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscular Diseases/etiology , Muscular Diseases/pathology , Muscular Diseases/physiopathology , Organ Size , SARS-CoV-2/physiology , Sarcopenia/diagnosis , Sarcopenia/epidemiology , Sarcopenia/etiology , Survivors/statistics & numerical data , Ultrasonography
3.
Radiol Med ; 127(4): 440-448, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1701515

ABSTRACT

OBJECTIVES: To assess the association between body composition measures in children with COVID-19 and severity of the disease course and clinical outcome. METHODS: A retrospective study of children (< 19 years) with COVID-19 admitted to the hospital who underwent CT of the chest and/or abdomen was conducted. Data compiled from electronic medical records included demographics, body mass index (BMI), length of stay, ICU admission, invasive mechanical ventilation and death. Waist circumference and perimeters for skeletal muscle mass (abdominal, psoas and paraspinal muscles) were measured on an axial CT image at the level of the twelfth thoracic vertebra or first lumbar vertebra using FIJI software. RESULTS: Fifty-seven subjects were identified (54% male, median age 15.6 years, 61% Hispanic, 23% African-American). 25% (14/57) were admitted to the ICU and 21% (12/57) needed intubation. 9% (5/57) died. Waist circumference ranged between 53.2 and 138.4 cm (mean 86.58 ± 18.74 cm) and skeletal muscle mass ranged between 0.6 and 6.8 cm2 (mean 3.5 ± 1.19 cm2). Lower skeletal muscle mass had a univariate association with ICU admission (odds ratio (OR) 0.4; 95%CI 0.17-0.76; p = 0.01) and mortality (OR 0.22; 95%CI 0.04-0.69; p = 0.01). Multivariate analysis showed similar association after controlling for comorbidities (adjusted OR 0.46; 95%CI 0.19-0.95; p = 0.04 and adjusted OR 0.31; 95%CI 0.06-0.95; p = 0.04, respectively). There was no association between BMI or waist circumference with ICU stay, mechanical ventilation or mortality. CONCLUSION: Lower skeletal muscle mass is associated with an adverse clinical course and outcome in children with COVID-19.


Subject(s)
COVID-19 , Adolescent , Body Composition , Body Mass Index , Child , Female , Humans , Male , Muscle, Skeletal/diagnostic imaging , Retrospective Studies , Tomography, X-Ray Computed/methods
4.
J Korean Med Sci ; 37(5): e32, 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674310

ABSTRACT

Dermatomyositis (DM) is one of the uncommon multi-organ idiopathic inflammatory myopathies that has been reported following the hepatitis B, Influenza, tetanus toxoid, H1N1, and BCG vaccines. However, an association with the coronavirus disease 2019 (COVID-19) vaccine is yet to be reported. In this case, we present the case of a 43-year-old Asian Indian female who was diagnosed with DM 10 days after receiving the second dosage of BNT162b2 mRNA COVID-19 vaccination, in the absence of any additional triggering factors. The diagnosis was established based on physical examination, serological antibodies, magnetic resonance imaging of the muscles, skin biopsy, and electromyography. She received standard treatment for DM, including oral high doses of prednisolone, hydroxychloroquine, mycophenolate, and physiotherapy. The treatment successfully reversed skin changes and muscle weakness. This is the first reported case of classic DM complicated by interstitial lung disease following COVID-19 vaccination. More clinical and functional studies are needed to elucidate this association. Clinicians should be aware of this unexpected adverse event following COVID-19 vaccination and arrange for appropriate management.


Subject(s)
/adverse effects , Dermatomyositis/diagnosis , Adult , COVID-19/prevention & control , COVID-19/virology , Dermatomyositis/etiology , Electromyography , Female , Humans , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Magnetic Resonance Imaging , Muscle, Skeletal/diagnostic imaging , SARS-CoV-2/isolation & purification , Skin/pathology , Vaccination/adverse effects
5.
In Vivo ; 36(1): 375-380, 2022.
Article in English | MEDLINE | ID: covidwho-1594652

ABSTRACT

BACKGROUND/AIM: The effect of sarcopenia on patients with severe Covid-19 disease is unknown. We aimed to assess the influence of baseline computed tomography (CT)-based body composition parameters (pectoralis muscle area, pectoralis muscle index, skeletal muscle gauge) on clinical variables in patients with severe Covid-19 disease. PATIENTS AND METHODS: Chest CT scans of adult patients with confirmed Covid-19 who were hospitalized from March 2020 to May 2021 at a level-one medical center in Germany were retrospectively analyzed. Pectoralis muscle area, pectoralis muscle index and skeletal muscle gauge were measured on the first CT scan after admission. Body composition parameters were assessed for association with clinical variables and 30-day mortality. RESULTS: A total of 46 patients were included. None of the body composition parameters was a predictor for 30-day mortality, duration of hospital stay, duration of intensive care unit treatment, or duration of invasive mechanical ventilation. CONCLUSION: Pectoralis muscle composition parameters in CT chest scans did not predict outcomes in adult patients with severe Covid-19 infection.


Subject(s)
COVID-19 , Sarcopenia , Adult , Humans , Muscle, Skeletal/diagnostic imaging , Pectoralis Muscles/diagnostic imaging , Retrospective Studies , SARS-CoV-2
6.
Viruses ; 13(11)2021 11 15.
Article in English | MEDLINE | ID: covidwho-1580430

ABSTRACT

Scientific evidence concerning the subacute and long-term effects of coronavirus disease 2019 (COVID-19) is on the rise. It has been established that infection by serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a systemic process that involves multiple organs. The complications and long-term consequences of COVID-19 are diverse and patients need a multidisciplinary treatment approach in the acute and post-acute stages of the disease. A significant proportion of COVID-19 patients experience neurological manifestations, some enduring for several months post-recovery. However, brain and skeletal muscle changes resultant from SARS CoV-2 infection remain largely unknown. Here, we provide a brief overview of the current knowledge, and usefulness, of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to investigate brain and skeletal muscles changes in Post-COVID-19 patients with persistent symptoms. Furthermore, a brief discussion of future 18F-FDG-PET/CT applications that might advance the current knowledge of the pathogenesis of post-COVID-19 is also provided.


Subject(s)
Brain/diagnostic imaging , Brain/metabolism , COVID-19/complications , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/metabolism , COVID-19/diagnostic imaging , COVID-19/metabolism , Chronic Disease , Fluorodeoxyglucose F18 , Humans , Positron Emission Tomography Computed Tomography
7.
Viruses ; 13(11)2021 11 15.
Article in English | MEDLINE | ID: covidwho-1524172

ABSTRACT

Scientific evidence concerning the subacute and long-term effects of coronavirus disease 2019 (COVID-19) is on the rise. It has been established that infection by serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a systemic process that involves multiple organs. The complications and long-term consequences of COVID-19 are diverse and patients need a multidisciplinary treatment approach in the acute and post-acute stages of the disease. A significant proportion of COVID-19 patients experience neurological manifestations, some enduring for several months post-recovery. However, brain and skeletal muscle changes resultant from SARS CoV-2 infection remain largely unknown. Here, we provide a brief overview of the current knowledge, and usefulness, of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to investigate brain and skeletal muscles changes in Post-COVID-19 patients with persistent symptoms. Furthermore, a brief discussion of future 18F-FDG-PET/CT applications that might advance the current knowledge of the pathogenesis of post-COVID-19 is also provided.


Subject(s)
Brain/diagnostic imaging , Brain/metabolism , COVID-19/complications , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/metabolism , COVID-19/diagnostic imaging , COVID-19/metabolism , Chronic Disease , Fluorodeoxyglucose F18 , Humans , Positron Emission Tomography Computed Tomography
8.
Skelet Muscle ; 11(1): 10, 2021 04 21.
Article in English | MEDLINE | ID: covidwho-1197351

ABSTRACT

BACKGROUND: SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. CASE PRESENTATION: We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. CONCLUSION: We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.


Subject(s)
COVID-19/physiopathology , Creatine Kinase/blood , Muscle, Skeletal/physiopathology , Muscular Diseases/physiopathology , Quadriplegia/physiopathology , Respiratory Distress Syndrome/physiopathology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/therapy , Critical Illness , Dexamethasone/therapeutic use , Electromyography , Glucocorticoids/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Intensive Care Units , Magnetic Resonance Imaging , Male , Methicillin-Resistant Staphylococcus aureus , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Muscular Diseases/blood , Muscular Diseases/diagnosis , Muscular Diseases/etiology , Neural Conduction , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Quadriplegia/etiology , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2 , Severity of Illness Index , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Ventilator Weaning
9.
Radiology ; 300(2): E328-E336, 2021 08.
Article in English | MEDLINE | ID: covidwho-1136121

ABSTRACT

Background Lower muscle mass is a known predictor of unfavorable outcomes, but its prognostic impact on patients with COVID-19 is unknown. Purpose To investigate the contribution of CT-derived muscle status in predicting clinical outcomes in patients with COVID-19. Materials and Methods Clinical or laboratory data and outcomes (intensive care unit [ICU] admission and death) were retrospectively retrieved for patients with reverse transcriptase polymerase chain reaction-confirmed SARS-CoV-2 infection, who underwent chest CT on admission in four hospitals in Northern Italy from February 21 to April 30, 2020. The extent and type of pulmonary involvement, mediastinal lymphadenopathy, and pleural effusion were assessed. Cross-sectional areas and attenuation by paravertebral muscles were measured on axial CT images at the T5 and T12 vertebral level. Multivariable linear and binary logistic regression, including calculation of odds ratios (ORs) with 95% CIs, were used to build four models to predict ICU admission and death, which were tested and compared by using receiver operating characteristic curve analysis. Results A total of 552 patients (364 men and 188 women; median age, 65 years [interquartile range, 54-75 years]) were included. In a CT-based model, lower-than-median T5 paravertebral muscle areas showed the highest ORs for ICU admission (OR, 4.8; 95% CI: 2.7, 8.5; P < .001) and death (OR, 2.3; 95% CI: 1.0, 2.9; P = .03). When clinical variables were included in the model, lower-than-median T5 paravertebral muscle areas still showed the highest ORs for both ICU admission (OR, 4.3; 95%: CI: 2.5, 7.7; P < .001) and death (OR, 2.3; 95% CI: 1.3, 3.7; P = .001). At receiver operating characteristic analysis, the CT-based model and the model including clinical variables showed the same area under the receiver operating characteristic curve (AUC) for ICU admission prediction (AUC, 0.83; P = .38) and were not different in terms of predicting death (AUC, 0.86 vs AUC, 0.87, respectively; P = .28). Conclusion In hospitalized patients with COVID-19, lower muscle mass on CT images was independently associated with intensive care unit admission and in-hospital mortality. © RSNA, 2021 Online supplemental material is available for this article.


Subject(s)
COVID-19/complications , Radiography, Thoracic/methods , Sarcopenia/complications , Sarcopenia/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Female , Humans , Italy , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Predictive Value of Tests , Retrospective Studies , SARS-CoV-2
11.
Int J Mol Sci ; 21(13)2020 Jun 30.
Article in English | MEDLINE | ID: covidwho-635082

ABSTRACT

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 hours and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.


Subject(s)
Cachexia , Coronavirus Infections/pathology , Obesity/pathology , Pneumonia, Viral/pathology , Adult , Aged , Betacoronavirus/isolation & purification , Body Composition , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Female , Humans , Liver/diagnostic imaging , Liver/metabolism , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/metabolism , Nutritional Status , Obesity/complications , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Prospective Studies , Risk Factors , SARS-CoV-2 , Tomography, X-Ray Computed
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