Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19

Geng, Yan; Du, Yongsheng; Peng, Na; Yang, Ting; Zhang, Shiyu; Wu, Fengfu; Ma, Qiang; Lin, Hualiang; Su, Lei

doi:10.21203/rs.3.rs-90892/v1

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Furthermore, rhabdomyolysis is a known cooccurrence [ 8 ] that might represent a contributing factor for adverse outcomes in some COVID-19 patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Increased Creatine Kinase May Predict A Worse COVID-19 Outcome

Orsucci

Trezzi²,

Anichini

et al. 2021

JCM

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Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy’s “first wave” was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on “severe” (n = 99) or “mild” (n = 232) outcomes. “Severe” disease is defined here as death and/or mechanical invasive ventilation, in contrast to “mild” patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10–1672 U/L, versus median, 82; range, 12–1499 U/L, p = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a “severe” outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both “severe” and “mild” patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified.

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“…Furthermore, rhabdomyolysis is a known cooccurrence [ 8 ] that might represent a contributing factor for adverse outcomes in some COVID-19 patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Increased Creatine Kinase May Predict A Worse COVID-19 Outcome

Orsucci

Trezzi²,

Anichini

et al. 2021

JCM

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“…In addition, it is important to emphasize that there was no evidence of publication bias and that the overall effect size was not affected in sensitivity analyses. A number of unreported factors might have contributed to the heterogeneity, particularly the coexistence of rhabdomyolysis, reported in COVID-19 patients and a common cause of increased serum CK-MB concentrations [ [92] , [93] , [94] ], and the fact that virtually all selected studies reported a single measurement of CK-MB rather than serial assessments.…”

Section: Discussionmentioning

confidence: 99%

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

Zinellu

Sotgia

Fois

et al. 2021

Advances in Medical Sciences

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Objectives We conducted a systematic review and meta-analysis with meta-regression of creatine kinase-MB (CK-MB), a biomarker of myocardial injury, in COVID-19 patients. Methods We searched PubMed, Web of Science and Scopus, for studies published between January 2020 and January 2021 that reported CK-MB, COVID-19 severity and mortality (PROSPERO registration number: CRD42021239657). Results Fifty-five studies in 11,791 COVID-19 patients were included in the meta-analysis. The pooled results showed that CK-MB concentrations were significantly higher in patients with high disease severity or non-survivor status than patients with low severity or survivor status (standardized mean difference, SMD, 0.81, 95% CI 0.61 to 1.01, p<0.001). The rate of patients with CK-MB values above the normal range was also significantly higher in the former than the latter (60/350 vs 98/1,780; RR=2.84, 95%CI 1.89 to 4.27, p<0.001; I 2 =19.9, p=0.254). Extreme between-study heterogeneity was observed (I 2 =93.4%, p<0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified (effect size range, 0.77 to 0.84). Begg's (p=0.50) and Egger's (p=0.86) t-tests did not show publication bias. In meta-regression analysis, the SMD was significantly and positively associated with the white blood count, aspartate aminotransferase, myoglobin, troponin, brain natriuretic peptide, lactate dehydrogenase, and D-dimer. Conclusions Higher CK-MB concentrations were significantly associated with severe disease and mortality in COVID-19 patients. This biomarker of myocardial injury might be useful for risk stratification in this group.

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“…Unfortunately, rhabdomyolysis with its symptoms such as fever, myalgia, and signs (elevated liver enzymes and lactate dehydrogenase) is similar to COVID-19 itself and may go unrecognized [ 22 ]. This is concerning as COVID-19 patients with concomitant rhabdomyolysis were found to have an increased risk of deterioration, increased risk of ICU admission (90.9% vs. 5.3%), increased mechanical ventilation (86.4% vs. 2.7%), and increased risk of in-hospital death [ 28 ]. Two independent risk factors for in-hospital deaths were creatine kinase (CK) levels greater than 1000 IU/L and serum myoglobin levels greater than 1000 ng/ml [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…This is concerning as COVID-19 patients with concomitant rhabdomyolysis were found to have an increased risk of deterioration, increased risk of ICU admission (90.9% vs. 5.3%), increased mechanical ventilation (86.4% vs. 2.7%), and increased risk of in-hospital death [ 28 ]. Two independent risk factors for in-hospital deaths were creatine kinase (CK) levels greater than 1000 IU/L and serum myoglobin levels greater than 1000 ng/ml [ 28 ]. However, Bach et al clarify that while both CK and myoglobin levels are monitored, Myoglobin levels are less useful in diagnosing rhabdomyolysis due to increased false-negative results, caused by myoglobin's short half-life [ 23 ].…”

Section: Introductionmentioning

confidence: 99%