April 20, 2022
2 min read
Source / Information
Wakefield C, et al. Star presentations: COVID-19. Presented at: Society of Critical Care Medicine Congress; 18.-21. April 2022 (virtual meeting).
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The presence of respiratory muscle wasting in patients with severe COVID-19 was associated with increased mortality in inpatients, according to a study presented at the Society of Critical Care Medicine Congress.
“Sarcopenia, or the condition of generalized muscle wasting and dysfunction, has been shown to be associated with poor outcomes across different patient populations.” Connor J. Wakefield, MD, resident physician in the Department of Internal Medicine at Brooke Army Medical Center in Fort Sam Houston, Texas, said during a presentation. “There is a lack of research examining the role of thoracic sarcopenia in critical illness and COVID-19 outcomes.”
Wakefield and colleagues aimed to implement a new technique to assess the degree of respiratory muscle wasting through the use of CT and body composition analysis and also to investigate the effect of respiratory muscle wasting on the outcomes of patients with severe COVID-19.
The retrospective single-center cohort study included 99 adults (median age, 64 years; 67% men) admitted to the intensive care unit with confirmed COVID-19 from March to December 2020. All patients underwent chest CT within 2 days of admission. Using medical image analysis software, the researchers assessed a cross-sectional area of respiratory skeletal muscle at the fifth thoracic vertebral level and calculated respiratory muscle index. Patients were categorized into the lowest sex-specific quartile of respiratory muscle index and the second to fourth sex-specific respiratory muscle index quartile.
The primary outcome was mortality. Secondary results including mechanical ventilation durationtracheostomy and hospitalization time.
Researchers observed respiratory muscle wasting in 19 patients. These patients were older (71.5 vs. 60.2 years), had lower BMI (26.4 vs. 32.1 kg / m2)2) and had lower mean respiratory muscle index (26.8 vs. 39.2 cm2/ m2).
C-reactive protein levels (P = .55), ferritin (P = 0.79), number of platelets (P = 0.33) and lactate dehydrogenase number (P = .15) were all similar between patients with respiratory muscle wasting and non-respiratory muscle wasting.
Compared with non-respiratory muscle wasting, patients in the group with respiratory muscle wasting had significantly decreased mean creatine kinase (586 vs. 536.2 U / L; P = .003).
The researchers reported no difference in COVID-19 targeted treatments received between the groups.
The results showed no significant differences in the degree of mechanical ventilation (44% vs. 53%; P = .563), mechanical ventilation duration (5.4 vs. 5 days; P = .729), rates for tracheostomy (6% vs. 5%; P = .972) or ICU length of stay (11.3 vs. 9.9 days; P = .761) between patients with non-respiratory muscle wasting and those with respiratory muscle wasting, respectively.
However, the presence of respiratory muscle wasting was associated with increased inpatient mortality compared (53% vs. 27%; P = 0.019). In addition, respiratory muscle wasting was associated with hospital mortality after adjustment for admission platelet level in multivariate models (OR = 3.3; 95% CI, 1.02–10.46; P = 0.047).
Wakefield highlighted several limitations of the study, including its retrospective single-center design and lack of early-stage CT scan for all patients with COVID-19. He said that this may represent a cohort with increased recombinant thoracic processes, such as pulmonary embolism, even though the frequency of PE in this cohort was low (10%).
“Future directions include performing serial analysis of CT scans over time in patients with mechanical ventilation dependence as a way to predict ventilator detoxification,” Wakefield said. “Prospective studies are also needed to examine the effects of various therapies, including respiratory muscle training and ventilation conditions, on the impact on ventilation we need for success.”