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Review
. 2022 Dec;41(12):2965-2972.
doi: 10.1016/j.clnu.2021.08.004. Epub 2021 Aug 16.

Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients

Sarah Damanti  1 , Giulia Cristel  2 , Giuseppe Alvise Ramirez  3 , Enrica Paola Bozzolo  4 , Valentina Da Prat  4 , Agnese Gobbi  5 , Clarissa Centurioni  5 , Ettore Di Gaeta  6 , Andrea Del Prete  6 , Maria Grazia Calabrò  7 , Maria Rosa Calvi  7 , Giovanni Borghi  7 , Alberto Zangrillo  8 , Francesco De Cobelli  2 , Giovanni Landoni  8 , Moreno Tresoldi  4
Affiliations
Review

Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients

Sarah Damanti et al. Clin Nutr. 2022 Dec.

Abstract

Background & aims: Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia.

Methods: This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available.

Results: A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00-1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95-0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96-0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01-1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β -0.07, 95% C.I. -0.13 - -0.002, p = 0.03), length of hospitalization (Β -1.36, 95% C.I. -2.21 - -0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78-0.99, p = 0.046).

Conclusions: Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.

Keywords: COVID-19; Intensive care unit; Muscle mass; Muscle quality; Ventilator weaning.

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Conflict of interest statement

Conflict of interest None.

Figures

Fig. 1
Fig. 1
Comparison of CT scans of a normal and a patient with reduced muscle mass. Segmentation of muscles on CT images (red) using density thresholding. Axial images at the L3 level of a patient with normal (a) and reduced (b) muscle mass. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
Outcomes of the univariable regression analyses. SMI = Skeletal Muscel Index. CSA = Cross Sectional Area.
See this image and copyright information in PMC

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