Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID‐19: a prospective observational study

Abstract

Background Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID‐19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID‐19 patients. Methods We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS‐CoV‐2 during hospitalization and were excluded from the analyses. Results The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m2. The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07–2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex‐specific mean and standard deviation (1.23 [95% CI: 1.06–1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross‐sectional area. The crude HR identified shorter hospital stay for patients with greater sex‐specific standardized values (1.20 [95% CI: 1.03–1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross‐sectional area (0.63 [95% CI: 0.46–0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross‐sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross‐sectional area remained consistent and statistically significant after adjusting for other covariates. Conclusions Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID‐19, which stresses the value of muscle health in prognosis of this disease.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment

“…In critically-ill septic patients, Cox Mc et al, reported a prevalence of baseline low muscle mass in 50% of patients [39]. Another study in hospitalized patients with COVID-19 showed that muscle mass was related to the need for ICU admission (17%), longer hospital LOS (mean, 10.8 days), and mortality (6.6%) [40]. Although their results are not comparable to our population of critically ill patients as muscle mass was assessed using ultrasound, their findings corroborate with ours by highlighting low muscle mass as an independent predictor of negative clinical outcomes [37], including higher rates of extubation failure, defined as reintubation within 48 hours after extubation following long-term MV for >7 days [41].…”

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

“…The authors were contacted to clarify any doubts about the articles. Unpublished data were requested, however, only the assessment of number of deaths caused by COVID-19 was used to perform the analysis ( 18 ).…”

Cytokines and Chemokines in Cancer Cachexia and Its Long-Term Impact on COVID-19

“…Gil et al assessed 196 hospitalized patients for vastus lateralis cross-sectional area using ultrasonography and concluded that low muscle mass contributes to higher skeleton muscle loss among COVID-19 patients due to increased demands of tissues such as liver and immune cells [90]. Those patients with weak muscle strength are more vulnerable to stress factors, which could be the case of COVID-19 [91,92]. Other studies have found that with COVID-19 treatment, 43% of study participants lost ≥5% of their body weight, and 25% of participants lost ≥10% of their body weight.…”