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The effect of pre-existing sarcopenia on outcomes of critically ill patients treated for COVID-19 Cover

The effect of pre-existing sarcopenia on outcomes of critically ill patients treated for COVID-19

The Journal of Critical Care Medicine
Volume 11 (2025): Issue 1 (January 2025)
By: ,  ,  ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Jan 2025
Figures & tables

Figures & Tables

Fig. 1.

Flow chart

Table 1.

Patients characteristics and outcomes.

VariablesPatients with sarcopenia n=75Patients without sarcopenia n = 75Total n = 150p
Age, years69.6 (+/−10)64.6 (+/−12.1)67.1 (+/−11.4)0.006
Male, n (%)59 (78)41 (41)100 (66.7)0.002
Comorbidities
Respiratory, n (%)25 (33)26 (34.7)51 (34)0.863
Cardiac, n (%)29 (38.7)39 (52)68 (45.3)0.101
Renal, n (%)6 (8)10 (13)16 (10.7)0.290
Diabetes, n (%)23 (30.7)29 (38.7)52 (34.7)0.303
Obesity**, n (%)19 (26)50 (66.7)69 (46.6)<0.001
BMI, kg/m227.3 (+/−4.7)33.1 (+/−6.6)30.3 (+/−6.4)<0.001
CT scan variables
Lung damage, n (%):
  Mild (<25%)21 (28)21 (28)42 (28)0.050
  Moderate (25–50%)42 (56)30 (40)72 (48)
  Severe (>50%)12 (16)24 (32)36 (24)
Pulmonary embolism, n (%)5 (6.8)1 (1.3)6 (4)0.102
SMA, cm270.5 (+/− 16.6)93.1 (+/−23.7)83.3 (+/−23.8)<0.001
SMI, cm2/m223.4 (+/− 4.5)32.7 (+/−6.9)28.8 (+/−7.5)<0.001
Scores
SAPS II36.1 (+/−14.7)33.7 (+/−12.1)34.9 (+/−13.5)0.267
SOFA5.4 (+/−8.1)3.6 (+/−2.9)4.34 (+/−5.8)0.089
Biological parameters on ICU admission
Lymphocytes, G/L0.84 (+/−0.83)1.11 (+/− 1.22)0.97 (+/−1.04)0.112
Albumin, g/L27.5 (+/−4.8)29 (+/−5.3)28.1 (+/−5.1)0.266
CRP, mg/L144.7 (+/− 116.2)119.5 (+/− 89.3)131.9 (+/−103.8)0.155
D-Dimers, μg/L1889.1 (+/−1632.6)1291.42 (+/1311.5)1598.5 (+/1508.5)0.038
Fibrinogen, mmol/L6.4 (+/−1.5)6.9 (+/−1.6)6.5 (+/−1.6)0.624
Outcomes
Mortality, n (%)12 (16)10 (13.3)22 (14.7)0.644
Pneumonia, n (%)15 (20)22 (29.3)37 (24.7)0.185
MV, n (%)21 (28)23 (37.3)44 (29.3)0.110
HFO duration, days5.8 (+/−4.6)4.0 (+/− 3)4.9 (+/− 4)0.005
MV duration, days6.9 (+/− 9)9.6 (+/− 12.1)8.5 (+/−10.9)0.233
ICU LOS, days12.1 (+/− 9.7)13.1 (+/− 12.2)12.6 (+/− 11)0.575
Hospital LOS, days26.9 (+/− 22.8)24.6 (+/− 20.6)25.8 (+/− 21.7)0.509

Data are presented as absolute values and percentages (n (%)) or mean (SD). BMI: Body Mass Index; HFO: High Flow Oxygen; LOS: Length Of Stay; MV: mechanical Ventilation; SMA: Skeletal Muscle Area; SMI: Skeletal Muscle Index.

** : combination of criterion 1 and a BMI > 30 kg/m2.

* : SMI<20.8 in r women and 28.8 in men or SMA <56.1 in women and 92.3 in men.

Table 2.

Effect of sarcopenia on High flow oxygen

VariablesPatients with sarcopenian =54Patients without sarcopenia n = 50Total n = 104p
Age, years69.1 (+/−1)63.9 (+/−13.4)66.6(+/−12.4)0.032
Male, n (%)42 (77.8)26 (52)68 (65.4)0.006
Comorbidities
Respiratory, n (%)17 (31.5)21 (42)38 (36.5)0.266
Cardiac, n (%)19 (35.2)25 (50)44 (42.3)0.127
Renal, n (%)3 (5.6)4 (8)7 (6.7)0.619
Diabetes, n (%)18 (33.3)19 (38)37 (35.6)0.619
BMI, kg/m227 (+/− 4.9)32.71 (+/−6.7)29.8 (+/−6.5)<0.001
CT-Scan variables
Lung damage, n (%):
  Mild (<25%)17 (31.5)15 (30)32 (30.8)0.795
  Moderate (25–50%)29 (53.7)24 (48)53 (51)
  Severe (50–75%)7 (13)9 (18)16 (15.4)
  Very severe (>75%)1 (1.9)2 (4)3 (2.9)
Pulmonary embolism, n (%)4 (7.4)1 (2)5 (4.8)0.198
Scores
SAPS II36.2 (+/−12.8)28.8 (+/−9.2)32.6 (+/−11.7)0.001
SOFA3.4 (+/−2.1)2.6 (+/−1.7)2.9 (+/−1.9)0.084
Biological parameters on ICU admission
Lymphocytes, G/L0.9 (+/−0.9)1.1 (+/− 1.4)1.0 (+/−1.2)0.298
Albumin, g/L29.2 (+/−4.9)29.5 (+/−3.3)29.3(+/−4.4)0.859
Outcomes
Mortality, n (%)6 (11.1)4 (8)10 (9.6)0,421
Pneumonia, n (%)1 (1.9)1 (2)2 (1.9)0.733
HFO duration, days6.8 (+/−4.4)5 (+/− 2.9)5.9 (+/−3.8)0.005
ICU LOS, days8.2 (+/− 5)6.3 (+/− 3.1)7.3 (+/− 4.3)0.019
Hospital LOS, days21.8 (+/− 17.6)17.1 (+/− 14.2)19.3 (+/−16.1)0.143

[i] Data are presented as absolute values and percentages (n (%)) or mean (SD). BMI: Body Mass Index; HFO: High Flow Oxygen; LOS: Length Of Stay.

Table 3.

Effect of mechanical ventilation at admission

VariablesMechanical ventilation on admission n =13No mechanical ventilation on admission n = 137Total n = 150p
Age, years67.1 (+/−11.4)67.13 (+/−11.4)67.13(+/−11.3)0.998
Male, n (%)6 (46.2)94 (68.6)100 (66.7)0.101
Comorbidities
Respiratory, n (%)3 (23.1)48 (35)51 (34)0.294
Cardiac, n (%)6 (46.2)62 (45.3)68 (45.3)0.950
Renal, n (%)1 (7.7)15 (10.9)16 (10.7)0.584
Diabetes, n (%)5 (30.8)48 (35)52 (34.7)0.509
Sarcopenia, n (%)4 (30.8)71 (51.8)75 (50)0.123
BMI, kg/m233.1(+/− 8)30.0 (+/−6.2)30.3 (+/−6.4)0.101
CT-Scan variables
Lung damage, n(%):
  Mild (<25%)3 (23.1)39 (28.5)42 (28)0.062
  Moderate (25–50%)3 (23.1)69 (50.4)72 (48)
  Severe (50–75%)6 (46.2)24 (17.5)30 (20)
  Very severe (>75%)1 (7.7)5 (3.6)6 (4)
Pulmonary embolism, n (%)0 (0)6 (4.4)6 (4)0.573
Scores
SAPS II46.8 (+/−18.7)33.8 (+/−12.1)34.9 (+/−13.5)0.001
SOFA6.0 (+/−4.2)4.2 (+/−6)4.3 (+/−5.8)0.276
Biological parameters at admission
Lymphocytes, G/L0.96 (+/−0.8)0.97 (+/− 1.1)0.97 (+/−1.1)0.968
Albumin, g/L28.8 (+/−8.1)28.0 (+/−4.5)28.1 (+/−5.1)0.670
Outcomes
Mortality, n (%)3 (23.1)19 (13.9)22 (14.7)0.292
Pneumonia, n (%)11 (84.6)26 (19)37 (24.7)<0.001
MV duration, days19.0 (+/− 9.6)6.8 (+/− 10.2)8.5 (+/−10.9)<0.001
ICU LOS, days23.7 (+/− 13.28)11.5 (+/− 10.2)12.6 (+/− 11.0)0.001
Hospital LOS, days34.0 (+/− 20.4)25.0 (+/− 21.7)25.8 (+/− 21.7)0.154

[i] Data are presented as absolute values and percentages (n (%)) or mean (SD). BMI: Body Mass Index; LOS: Length Of Stay; MV: mechanical Ventilation

Table 4.

Effect of sarcopenia in obese patients

VariablesObese patients with sarcopenia n =19Obese patients without sarcopenia n = 50Total n = 69p
Age, years69.8 (+/−10.5)63.17 (+/−12.8)65 (+/−12.5)0.048
Male, n (%)14 (73.7)28 (56)32 (60.9)0.179
Comorbidities
Respiratory, n (%)9 (47.4)22 (44.0)31 (44.9)0.802
Cardiac, n (%)8 (42.1)27 (54)35 (50.7)0.377
Renal, n (%)3 (15.8)10 (20)13 (18.8)0.689
Diabetes, n (%)8 (42.1)24 (48)32 (46.4)0.661
BMI, kg/m233.2 (+/− 4.5)36.3 (+/−5.7)35.5 (+/−5.6)0.036
CT scan variables
SMA, cm266.4 (+/− 12.1)99.5 (+/−25)90.9 (+/−27.3)<0.001
SMI, cm2/m223.0 (+/− 7.6)34.9 (+/−7.4)31.79 (+/−8.6)<0.001
Scores
SAPS II35.8 (+/−17.6)34.1 (+/−11.9)34.6 (+/−13.6)0.652
SOFA7.2 (+/−11.6)3.8 (+/−2.8)4.5 (+/−5.8)0.069
Biological parameters at admission
Lymphocytes, G/L1.00 (+/−1.4)1.01 (+/− 0.6)1.01 (+/−0.9)0.971
Albumin, g/L28.8 (+/−6)28.7 (+/−6)28.8 (+/−6)0.94
Outcomes
Mortality, n (%)4 (21.1)5 (10)9 (13)0.223
Pneumonia, n (%)6 (31.6)16 (32)22 (31.9)0.973
MV, n (%)7 (36.8)18 (36.0)25 (36.2)0.984
HFO duration, days4.6 (+/−3.3)3.6 (+/− 2.7)3.9 (+/−2.9)0.207
MV duration, days8.0 (+/− 8.1)11.8 (+/− 13.5)10.8 (+/−12.4)0.367
ICU LOS, days12.5 (+/− 8.7)14.7 (+/− 14.2)14.1 (+/− 12.9)0.518
Hospital LOS, days263.8 (+/− 22.4)25.5 (+/− 21.3)25.1 (+/− 21.5)0.768

[i] Data are presented as absolute values and percentages (n (%)) or mean (SD). BMI: Body Mass Index; HFO: High Flow Oxygen; LOS: Length Of Stay; MV: mechanical Ventilation; SMA: Skeletal Muscle Area; SMI: Skeletal Muscle Index.

DOI: https://doi.org/10.2478/jccm-2024-0045 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
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Language: English
Page range: 33 - 43
Submitted on: Oct 18, 2024
Accepted on: Nov 21, 2024
Published on: Jan 31, 2025
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
COVID-19,
Skeletal Muscle Index,
sarcopenia,
sarcopenic obesity,
death,
Intensive Care Unit
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2025 Thomas Bradier, Sébastien Grigioni, Céline Savoye-Collet, Gaétan Béduneau, Dorothée Carpentier, Christophe Girault, Maximillien Grall, Grégoire Jolly, Najate Achamrah, Fabienne Tamion, Zoé Demailly, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 11 (2025): Issue 1 (January 2025)
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