Muscle involvement in SARS-CoV-2 infection

Abstract

Background and purpose: Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, several reports indicated neurological involvement in COVID-19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia.

Methods: Creatine kinase, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalised COVID-19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID-19 patients were additionally compared to an historical group of hospitalised influenza patients.

Results: Three hundred fifty-one patients with SARS-CoV-2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID-19 and in 28% of influenza patients. CK was higher in severe COVID-19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID-19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of intensive care unit (ICU)-admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU-admitted COVID-19 patients.

Conclusions: HyperCKemia occurs in a similar frequency in COVID-19 and influenza infection. CK levels were lower in COVID-19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus-triggered inflammatory response or direct muscle toxicity.

Keywords: COVID-19; creatine kinase; hyperCKemia; influenza.

FIGURE 1

Creatine kinase and inflammatory markers during COVID‐19 disease course. (a) Data for patients with mild versus severe disease. Group comparisons (ICU versus non‐ICU) were performed by Mann‐Whitney U test and revealed statistically significant differences for all biomarkers at every time point (baseline, day 7, day 14): all p ≤ 0.001 except CK at baseline (p = 0.009) and day 7 (p = 0.005). (b) Data of survivors versus nonsurvivors. Group comparisons (survivor versus nonsurvivor) were performed by Mann‐Whitney U test and revealed statistically significant differences (p < 0.05) for all biomarkers at every time point (baseline, day 7, day 14) except CRP at baseline and ferritin at baseline and day 14. CK, creatine kinase; CRP, C‐reactive protein; G/l, Giga per liter; ICU, intensive care unit; IL, interleukin; WBC, white blood cells