Function Over Mass: A Meta-Analysis on the Importance of Skeletal Muscle Quality in COVID-19 Patients

Pinto, Fábio Roberto; Andrade, Márcia Fábia; Silva, Guilherme Henrique Gatti da; Faiad, Jaline Zandonato; Barrére, A.P.N.; Gonçalves, Renata de Castro; Castro, Gabriela Salim de; Seelaender, Marília

doi:10.3389/fnut.2022.837719

Cited by 23 publications

(24 citation statements)

References 53 publications

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“…We were more interested in whether diagnostic parameters of sarcopenia could be the predictor of clinical outcomes after adjusting other confounders. The majority of the studies found that CT-derived body composition parameters are linked to poorer outcomes in patients with COVID-19, which is in line with recent meta-analysis findings, indicating that sarcopenia was associated with increased severity and mortality from COVID-19 ( 28 , 34 , 66 ). Ufuk et al ( 26 ) reported that pectoralis muscle area (PMA) and index (PMI) values on chest CT were significantly associated with several adverse outcomes, such as intubation, prolonged hospital stay, and death.…”

Section: Discussionsupporting

confidence: 83%

“…We were more interested in whether diagnostic parameters of sarcopenia could be the predictor of clinical outcomes after adjusting other confounders. The majority of the studies found that CT-derived body composition parameters are linked to poorer outcomes in patients with COVID-19, which is in line with recent meta-analysis findings, indicating that sarcopenia was associated with increased severity and mortality from COVID-19 (28,34,66) (29) showed that patients with low muscle mass (defined by SMI on L3 level) had a significantly higher rate of tracheostomy (50 vs. 20%, p = 0.01), prolonged ICU (adjusted HR = 0.53, 95%CI: 0.30-0.92, p = 0.024), and hospital LOS (adjusted HR = 0.50, 95% CI: 0.29-0.86, p = 0.014). Another study by Kim et al (42) also showed that baseline sarcopenia (defined by SMI on T12 level) was an independent predictor of delayed hospital discharge (adjusted hazard ratio = 0.47; 95% CI 0.23-0.96).…”

Section: Discussionsupporting

confidence: 82%

“…Previous studies have also found a significant association between reduced muscle strength and COVID-19 severity ( 31 , 33 ). Additionally, according to a published meta-analysis, there is evidence that skeletal muscle quality, rather than mass, is associated with COVID-19 severity ( 34 ).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

Xu²,

Peng³

et al. 2022

Front. Nutr.

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BackgroundIt has been speculated that patients with sarcopenia are aggravated by the current novel coronavirus disease 2019 (COVID-19) epidemic. However, there is substantial uncertainty regarding the prevalence of sarcopenia in patients with COVID-19.ObjectivesThe purpose of the study was to systematically evaluate the prevalence of sarcopenia in patients with COVID-19, including stratification by gender, study location, study population, study design, and diagnostic criteria.DesignThis is the systematic literature review and meta-analysis.MethodsAn electronic search was performed in MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science and Scopus to identify observational studies reporting a prevalence estimate for sarcopenia in patients with COVID-19. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Risk of bias (RoB) was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) manual for cross-sectional studies, and Stata 14.0 was used to perform meta-analyses.ResultsA total of 4,639 studies were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 151 full-text studies. A total of 21 studies, including 5,407 patients, were eligible for inclusion in this review finally. The prevalence of sarcopenia in patients with COVID-19 in individual studies varied from 0.8 to 90.2%. The pooled prevalence of sarcopenia in COVID-19 was 48.0% (95% confidence interval, CI: 30.8 to 65.1%, I2 = 99.68%, p = 0.000). We did not find any significant differences in the prevalence estimates between gender specificity (OR = 1.34; 95% CI = 0.80–2.26; p = 0.001). By sex, the prevalence was 42.5% (95% CI: 31.7 to 53.4%) in men and 35.7% (95% CI: 24.2 to 47.2%) in women. The prevalence estimates significantly varied based on population settings and different diagnostic criteria of sarcopenia. ICU patients (69.7, 95% CI: 51.7 to 85.2%) were more likely to suffer from sarcopenia compared to other population settings.ConclusionTo our knowledge, this is the first meta-analysis reporting on the prevalence of sarcopenia in patients with COVID-19. Sarcopenia is frequently observed in patients with COVID-19, with varying prevalence across population settings. This study would be useful for clinicians to prompt the increasing awareness of identifying sarcopenia and developing interventions at patients with COVID-19 with high risk of sarcopenia. Further prospective longitudinal studies to define the association of sarcopenia and its prognostic outcomes in COVID-19 survivors are urgently needed to propose the most appropriate treatment strategies during their admission and discharge.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42022300431].

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Section: Discussionsupporting

confidence: 83%

“…We were more interested in whether diagnostic parameters of sarcopenia could be the predictor of clinical outcomes after adjusting other confounders. The majority of the studies found that CT-derived body composition parameters are linked to poorer outcomes in patients with COVID-19, which is in line with recent meta-analysis findings, indicating that sarcopenia was associated with increased severity and mortality from COVID-19 (28,34,66) (29) showed that patients with low muscle mass (defined by SMI on L3 level) had a significantly higher rate of tracheostomy (50 vs. 20%, p = 0.01), prolonged ICU (adjusted HR = 0.53, 95%CI: 0.30-0.92, p = 0.024), and hospital LOS (adjusted HR = 0.50, 95% CI: 0.29-0.86, p = 0.014). Another study by Kim et al (42) also showed that baseline sarcopenia (defined by SMI on T12 level) was an independent predictor of delayed hospital discharge (adjusted hazard ratio = 0.47; 95% CI 0.23-0.96).…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

Xu²,

Peng³

et al. 2022

Front. Nutr.

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“…Another study demonstrated that a high IMAT index (>2.35) measured at the T12 level on chest CT was associated with high 21-day mortality in patients with COVID-19 [ 21 ]. In a meta-analysis, the presence of low muscle quality, defined as low skeletal muscle density, was associated with COVID-19 mortality, despite high heterogeneity [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sarcopenia has been closely associated with prolonged hospital stay, including ICU care and/or invasive mechanical ventilation [ 19 , 33 ] and long-standing COVID-19 syndrome [ 18 ]. However, a meta-analysis showed no association between SMI and survival rate in patients with COVID-19 [ 30 ]. In our study, sarcopenia was not associated with four-month mortality.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Myosteatosis on Mortality in Hospitalized Patients with COVID-19

et al. 2022

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Body composition, including sarcopenia, adipose tissue, and myosteatosis, is associated with unfavorable clinical outcomes in patients with coronavirus disease (COVID-19). However, few studies have identified the impact of body composition, including pre-existing risk factors, on COVID-19 mortality. Therefore, this study aimed to evaluate the effect of body composition, including pre-existing risk factors, on mortality in hospitalized patients with COVID-19. This two-center retrospective study included 127 hospitalized patients with COVID-19 who underwent unenhanced chest computed tomography (CT) between February and April 2020. Using the cross-sectional CT images at the L2 vertebra level, we analyzed the body composition, including skeletal muscle mass, visceral to subcutaneous adipose tissue ratio (VSR), and muscle density using the Hounsfield unit (HU). Of 127 patients with COVID-19, 16 (12.6%) died. Compared with survivors, non-survivors had low muscle density (41.9 vs. 32.2 HU, p < 0.001) and high proportion of myosteatosis (4.5 vs. 62.5%, p < 0.001). Cox regression analyses revealed diabetes (hazard ratio [HR], 3.587), myosteatosis (HR, 3.667), and a high fibrosis-4 index (HR, 1.213) as significant risk factors for mortality in patients with COVID-19. Myosteatosis was associated with mortality in hospitalized patients with COVID-19, independent of pre-existing prognostic factors.

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Dual-Energy CT muscle fat fraction as a new imaging biomarker of body composition and survival predictor in critically ill patients

Erley,

Roedl,

Ozga

et al. 2024

Eur Radiol

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Objective To analyze changes in the muscular fat fraction (FF) during immobilization at the intensive care unit (ICU) using dual-energy CT (DECT) and evaluate the predictive value of the DECT FF as a new imaging biomarker for morbidity and survival. Methods Immobilized ICU patients (n = 81, 43.2% female, 60.3 ± 12.7 years) were included, who received two dual-source DECT scans (CT1, CT2) within a minimum interval of 10 days between 11/2019 and 09/2022. The DECT FF was quantified for the posterior paraspinal muscle by two radiologists using material decomposition. The skeletal muscle index (SMI), muscle radiodensity attenuation (MRA), subcutaneous-/ visceral adipose tissue area (SAT, VAT), and waist circumference (WC) were assessed. Reasons for ICU admission, clinical scoring systems, therapeutic regimes, and in-hospital mortality were noted. Linear mixed models, Cox regression, and intraclass correlation coefficients were employed. Results Between CT1 and CT2 (median 21 days), the DECT FF increased (from 20.9% ± 12.0 to 27.0% ± 12.0, p = 0.001). The SMI decreased (35.7 cm2/m2 ± 8.8 to 31.1 cm2/m2 ± 7.6, p < 0.001) as did the MRA (29 HU ± 10 to 26 HU ± 11, p = 0.009). WC, SAT, and VAT did not change. In-hospital mortality was 61.5%. In multivariable analyses, only the change in DECT FF was associated with in-hospital mortality (hazard ratio (HR) 9.20 [1.78–47.71], p = 0.008), renal replacement therapy (HR 48.67 [9.18–258.09], p < 0.001), and tracheotomy at ICU (HR 37.22 [5.66–245.02], p < 0.001). Inter-observer reproducibility of DECT FF measurements was excellent (CT1: 0.98 [0.97; 0.99], CT2: 0.99 [0.96–0.99]). Conclusion The DECT FF appears to be suitable for detecting increasing myosteatosis. It seems to have predictive value as a new imaging biomarker for ICU patients. Clinical relevance statement The dual-energy CT muscular fat fraction appears to be a robust imaging biomarker to detect and monitor myosteatosis. It has potential for prognosticating, risk stratifying, and thereby guiding therapeutic nutritional regimes and physiotherapy in critically ill patients. Key Points The dual-energy CT muscular fat fraction detects increasing myosteatosis caused by immobilization. Change in dual-energy CT muscular fat fraction was a predictor of in-hospital morbidity and mortality. Dual-energy CT muscular fat fraction had a predictive value superior to established CT body composition parameters.

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Function Over Mass: A Meta-Analysis on the Importance of Skeletal Muscle Quality in COVID-19 Patients

Cited by 23 publications

References 53 publications

Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

Prognostic Impact of Myosteatosis on Mortality in Hospitalized Patients with COVID-19

Dual-Energy CT muscle fat fraction as a new imaging biomarker of body composition and survival predictor in critically ill patients

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