Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study

Abstract

Rationale and objectives: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission.

Materials and methods: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height², and muscle gauge as PMI x muscle density.

Results: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001.

Conclusion: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.

Keywords: COVID-19; sarcopenia; survival.

Figure 1

Imaging findings in a 55- year-old woman with COVID-19. Pectoralis muscle area = 14,48 cm², pectoralis muscle density = 28 HU, pectoralis muscle index = 5.19, pectoralis muscle gauge = 145.3. The patient died on the day 19 after admission. (Color version of figure is available online.)

Figure 2

Imaging findings in a 61- year-old old man with COVID-19. Pectoralis muscle area = 28.17 cm², pectoralis muscle density = 30 HU, pectoralis muscle index = 8.69, pectoralis muscle gauge = 260.7. The patient was discharged in good health. (Color version of figure is available online.)