COVID-19 News: Italian Study Shows That Sarcopenia Is A Common Manifestation In SARS-CoV-2 Infections, Especially In Those Hospitalized

COVID-19 News: Researchers from the Department of Rehabilitation and Functional Recovery and also the Department of Neurosurgery and Gamma Knife Radiosurgery at IRCCS San Raffaele Scientific Institute-Milan-Italy, have in a new study found that Sarcopenia is a common manifestation in SARS-CoV-2 infections, especially in those who were hospitalized when infected or are older.

Sarcopenia is a condition characterized by loss of muscle mass, strength, and function typically due to aging but other medical conditions can also lead to it. Sarcopenia is type of muscle atrophy that results in muscle weakness and some believe that diets and lack of exercise can also contribute to it.
 
Besides muscle weakness, typical symptoms of sarcopenia may include: Loss of stamina, Difficulty performing daily activities, Walking slowly, Trouble climbing stairs, Poor balance and falls, Decrease in muscle size.
 
According to the study team and even previous COVID-19 News coverages, many COVID-19 patients who require hospitalization in the first phase of the disease benefit from respiratory, motor or cognitive rehabilitation before being dismissed from the hospital.
 
During this rehabilitative phase, these patients are still positive for SARS-CoV-2 and potentially infectious, although their symptoms might differ from the symptoms, they encountered in the first days. The study findings showed that 41% of these patients presented with sarcopenia, which represents a drastic loss of muscle mass. The study team noticed that the risk factors associated with sarcopenia were ageing, depression, being a woman and having more issues with being independent in daily life.
 
The study team aimed to investigate the clinical symptoms and specific care requirements of SARSCoV-2 patients who were admitted to a COVID-19 Rehabilitation Unit while still infectious for SARSCoV-2 and in the subacute phase of the disease.
 
Patients admitted to their COVID-19 Rehabilitation Unit from March 2020 to December 2020 were evaluated for sarcopenia, and they also completed the following assessments: functional independence measure, short physical performance battery and Hamilton Rating Scale for Depression. Age and body mass index and symptoms of dysosmia or dysgeusia were also recorded.
 
In all, a total of 126 patients were enrolled (50 women, median age 72 years, 18.7 years), of whom 82% of patients presented with low grip strength.
 
The study findings showed that sarcopenia was diagnosed in 52 patients.
 
The study findings showed that sarcopenic patients were older than nonsarcopenic ones (median age 73.4 years, IQR 13.2 vs 63.9 years, IQR 14.5, respectively, p = 0.014).
 
The study team found that sarcopenia was associated with the presence of depression (p = 0.008), was more common in women (p = 0.023) and was associated with greater functional deficits (functional independence measure and short physical performance battery analyses, p < 0.05). Sarcopenic patients also had a lower body mass index than other patients (p < 0.01).
 
The study findings showed that more than 40% of our patients suffered from sarcopenia, which was associated with ageing, depression, l ow body mass index, reduction in functional autonomy and being a woman. Such data provide evidence for the need to assist hospitalized COVID-19 patients by means of a multidisciplinary specialist team.
 
The study findings were published in the peer reviewed Journal of Rehabilitation Medicine- Clinical Communications.
https://medicaljournalssweden.se/jrm-cc/article/view/2222
 
The study team said that with regards to their study findings, it is highly probable that sarcopenia might have been induced, at least in part, by the elevated inflammatory response in these patients who were in need of hospitalization.
 
They also said that other factors might have influenced the outcome of sarcopenia could be physical inactivity because of prolonged bed rest, or an inadequate intake of energy or protein.
 
It has been found that SARS-CoV-2 infection has been associated with a risk of malnutrition that might be related to a reduction of food intake caused by nausea, diarrhea and loss of appetite.
https://pubmed.ncbi.nlm.nih.gov/32433599/
 
The study findings showed that sarcopenia is a clinical condition that should be taken into consideration in SARS-CoV-2 patients.
 
It was recommended that adequate clinical investigations should be undertaken upon admission of the patient in order to counteract underdiagnosed sarcopenia, and the patient’s clinical status should be carefully monitored during the hospitalization by a multidisciplinary team.
 
The study findings further confirm the need for a multidisciplinary team composed of neurologists, physiatrists, psychologists, nutritionists, cardiologists and physiotherapists in the rehabilitation of subacute COVID-19 patients.
 
The findings indicated that sarcopenic patients were the most compromised patients from a functional point of view, the most depressed, with BMI indicative of being underweight, the most aged patients, more often women and with no signs of dysosmia. 
 
The study findings also showed that approximately 40% of patients suffered from mild to moderate depression. It has been reported that psychiatric illnesses, cognitive disorders and depression are frequent in this subacute phase of the disease, as well as in the long term, and are often present concurrently.
 
Such clinical signs of early depression can worsen in the following weeks, leading to the appearance of post-traumatic stress disorder, especially in patients who under-went orotracheal intubation and who have been recovered in ICU in the acute phase. 
 
Interestingly, sarcopenia and depression seem to share several common risk factors, such as physical inactivity, upregulation of inflammatory cytokines and dysregulation of hormones in the hypothalamic-pituitary-adrenal axis.
https://pubmed.ncbi.nlm.nih.gov/26136791/
 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786540/
 
https://pubmed.ncbi.nlm.nih.gov/28633395/
 
A past study showed that age, sex and BMI were covariates of sarcopenia. They also showed that other confounders were cognitive function, physical performance, activities of daily living, smoking and drinking habits, diabetes mellitus and cardiovascular disease.
https://pubmed.ncbi.nlm.nih.gov/27816484/
 
The study findings also showed that sarcopenia was highly correlated with decreased functional autonomy, as demonstrated by the FIM evaluation. 
 
The study team’s analyses of patients’ clinical symptoms showed a reduced proportion of dysosmia (29%) and dysgeusia (19%) among the patient population, compared to what has been described of the acute phase of the disease ie from about 35% up to 80–90% of patients.
 
The main limitation of this study lies in the fact that none of these patients benefited from nutritional status evaluation before SARS-CoV-2 infection. Hence, although history of sarcopenia had been excluded from the anamnesis, it cannot rule out the possibility that some of these patients might have already had signs of sarcopenia before their admission to the hospital.
 
The study findings revealed evidence that hospitalized COVID-19 patients who suffer from functional impairments that prohibit them from being autonomous should be provided with multidisciplinary rehabilitative care that addresses the specific clinical conditions encountered in the subacute phase of COVID-19, including sarcopenia. The complexity of these conditions justifies the need to provide patients with regular follow-ups after the end of the rehabilitative period.
 
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