Background Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). Materials and Methods 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. Results prevalence of sarcopenia was high (41,5%) but significantly different in each pandemic wave (57,9% vs 21,6% p<0,0000). At the multivariate analysis, sarcopenia during the first wave (Hazard Ratio 2,29, 95% confidence intervals1,17 to 4,49 p=0,0162) was the only independent prognostic factor for adverse clinical outcome. There were no significant differences in comorbidities and COVID19 severity in terms of pulmonary involvement at lung CT comparing during the first and second wave. Mixed pattern with peripheral and central involvement was found to be dominant in both groups. Conclusion: we highlight the prognostic impact of sarcopenia in COVID-19 patients hospitalized during the first wave. T12 SMA could represent a potential tool to identify sarcopenic patients in particular settings. Further studies are needed to better understand the association between sarcopenia and COVID-19.

for the persistence at home of watery diarrhoea and abdominal pain over the previous 10 days.For these symptoms, he had taken rifaximine and loperamide without benefit. He denied fever, blood or mucus in the stools. He had neither family history of inflammatory bowel disease, nor had travelled abroad over the prior months. In his medical history, in 1997 an idiopathic dilated cardiomyopathy was diagnosed when the patient was admitted to the hospital for stroke. Since then he had taken warfarin, along with digoxin, ramipril, furosemide, lansoprazole; he reported intolerance to beta blockers.Upon admission, the patient was conscious and co-operative, blood pressure 100/60 mmHg, heart rate 90 beats/ min., and normal O 2 saturation. Clinical examination was substantially normal; except for the presence of bilateral leg edema. BMI was 24. We performed an ECG ( Fig. 1) that showed normal sinus rhythm with left bundle branch block, and a short run of ventricular tachycardia; an X-ray of the abdomen was normal, whereas a chest radiography revealed ''cardiomegaly'' with initial apical flow distribution.Biochemistry showed PTL 496,000/mm 3 , the prothrombin time exceeding the therapeutic range, severe protein deficiency with 1.85 g/dl albumin, elevation of CRP (3.56 mg/dl), mild hypokalemia, severe iron deficiency (lowered serum iron and serum ferritin without transferrin elevation).Mild rehydration and albumin supplementation were started during the initial days, then replaced by total parenteral nutrition. DiagnosisDr. Boldrini, Dr. Romagnoli: Thyroid function was normal and stool culture negative; both tissue transglutaminase (100 U/ll) IgA endomysial antibodies were positive, with total serum IgA in the normal range.In order to perform upper gastrointestinal (UGI) endoscopy, warfarin was discontinued and replaced by enoxaparin: UGI endoscopy showed appreciable reduction with scalloped configuration; histopathology examination documented partial villous atrophy with increased number of intra-epithelial lymphocytes (Lesion 3A, Marsh Classification).Echocardiography showed severe dilatation and global hypokinesis of left ventricle (ejection fraction 25%) with functional mitral insufficiency, severe left atrial enlargement, presence of ventricular dyssynchrony.Twelve hours after the upper GI endoscopy the patient presented confusion and dysarthria: a head CT scan showed an acute ischemic lesion in the left cerebellar hemisphere whereas carotid Doppler scan was normal. The symptoms disappeared on the following day. The patient was discharged after 20 days with a diagnosis of ''celiac disease with severe malnutrition, cerebellar ischemic stroke (probably cardioembolic) in patient with idiopathic dilated cardiomyopathy''.