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. 2023 Dec 25;16(1):13-25.
doi: 10.3390/idr16010002.

Urea/Creatinine Ratio's Correlation with Creatine Kinase Normalization in Pediatric COVID-19 Patients with Myositis: Evaluating Prognostic and Predictive Value

Francesco Pizzo  1 , Andrea Marino  2 , Alessandra Di Nora  1 , Serena Spampinato  3 , Giovanni Cacciaguerra  1 , Giuseppe Costanza  1 , Federica Scarlata  1 , Arturo Biasco  1 , Maria Chiara Consentino  1 , Riccardo Lubrano  4 , Bruno Cacopardo  2 , Giuseppe Nunnari  2 , Martino Ruggieri  5 , Piero Pavone  5
Affiliations

Urea/Creatinine Ratio's Correlation with Creatine Kinase Normalization in Pediatric COVID-19 Patients with Myositis: Evaluating Prognostic and Predictive Value

Francesco Pizzo et al. Infect Dis Rep. .

Abstract

Coronavirus disease 2019 (COVID-19) has been chiefly linked with substantial respiratory complications. However, emerging studies have brought attention to the occurrence of severe muscle inflammation (myositis) related to COVID-19, potentially leading to multi-organ failure and increased mortality. Myositis is generally characterized by heightened serum creatine kinase (CK) levels. Acute myositis is characterized by an infiltration of viruses into calf muscle fibers, which may cause a subsequent inflammatory response leading to calf muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. While the association between myositis and severe outcomes has been recognized in adults, it remains less understood in the pediatric population. The current retrospective study, conducted at Policlinico San Marco University Hospital in Catania, aimed to analyze clinical and laboratory factors associated with myositis in pediatric patients with SARS-CoV-2 infection. Between January 2022 and January 2023, ten pediatric patients diagnosed with myositis and SARS-CoV-2 infection were evaluated. The study highlighted clinical manifestations such as fever, calf muscle pain, and abnormal gait. Lab results showed elevated CK levels among other findings. All patients underwent treatment, with the majority recovering without complications. A notable correlation was observed between CK levels, blood urea nitrogen (BUN), and the urea/creatinine ratio (UCR). The study also discusses potential pathophysiological mechanisms behind SARS-CoV-2's impact on skeletal muscles, emphasizing an indirect inflammatory response. Our findings underscore that while myositis in children with SARS-CoV-2 infection appears to follow a benign and self-limiting trajectory, it is crucial to monitor specific markers for early intervention and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes.

Keywords: COVID-19 myolysis; COVID-19 myositis; SARS-CoV-2 infection; pediatric COVID-19.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patients’ clinical enrollment.
Figure 2
Figure 2
Linear regression graph, showing a correlation between the number of days necessary for the normalization of CK levels and the UCR ratio (R2 = 0.7222).
Figure 3
Figure 3
Exponential function curve between UCR values and days for CK normalization. Normalization of CK (days) = 7.08 × e(0.1148 × UCR) − 4.05.
Figure 4
Figure 4
Linear regression graph, showing a correlation (a) between CK levels and BUN (mg/L), and (b) between CK levels and UCR ratio.
See this image and copyright information in PMC

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