Sarcopenia is a Frequent Disease in Sars-Cov-2 Infection

Authors

  • Sandro Iannaccone Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Luigia Brugliera Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Alfio Spina Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Gianluca Nocera Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Andrea Tettamanti Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Alessandra Giordani Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Sara Angelone Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Paola Castellazzi Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Paolo Cimino Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Jeffrey D. Padul Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Elise Houdayer Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • Federica Alemanno Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy

DOI:

https://doi.org/10.2340/jrmcc.v6.2222

Keywords:

SARS-CoV-2, sarcopenia, rehabilitation, COVID-19

Abstract

Objective: We 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.
Methods: Patients admitted to our 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.
Results: 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. Sarcopenia was diagnosed in 52 patients. 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). 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).
Conclusion: More than 40% of our patients suffered from sarcopenia, which was associated with ageing, depression, low 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.

LAY ABSTRACT
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 objective of this study was to examine the clinical condition of 126 COVID-19 patients in a COVID-19 rehabilitation ward. Our data demonstrated that 41% of these patients presented with sarcopenia, which represents a drastic loss of muscle mass. We noticed that the risk factors associated with sarcopenia were ageing, depression, being a woman and having more issues with being independent in daily life. These results reveal the importance of providing such COVID-19 patients with specific care by multidisciplinary teams of healthcare professionals.

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References

Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020; 92(6): 568–576. https://doi.org/10.1002/jmv.25748 DOI: https://doi.org/10.1002/jmv.25748

Gautret P, Million M, Jarrot PA, Camoin-Jau L, Colson P, Fenollar F, et al. Natural history of COVID-19 and therapeutic options. Expert Rev Clin Immunol 2020; 16(12): 1159–1184. https://doi.org/10.1080/1744666X.2021.1847640 DOI: https://doi.org/10.1080/1744666X.2021.1847640

Zhou Y, Li W, Wang D, Mao L, Jin H, Li Y, et al. Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol 2020; 5(2): 177–179. https://doi.org/10.1136/svn-2020-000398 DOI: https://doi.org/10.1136/svn-2020-000398

Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, et al. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 2020; 41(8): 2029–2031. https://doi.org/10.1007/s10072-020-04525-z DOI: https://doi.org/10.1007/s10072-020-04525-z

Chen L, Liu M, Zhang Z, Qiao K, Huang T, Chen M, et al. Ocular manifestations of a hospitalised patient with confirmed 2019 novel coronavirus disease. Br J Ophthalmol 2020; 104(6): 748–751. https://doi.org/10.1136/bjophthalmol-2020-316304 DOI: https://doi.org/10.1136/bjophthalmol-2020-316304

Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol 2020; 41(11): 3039–3056. https://doi.org/10.1007/s10072-020-04708-8 DOI: https://doi.org/10.1007/s10072-020-04708-8

Brugliera L, Filippi M, Del Carro U, Butera C, Bianchi F, Castellazzi P, et al. Nerve compression injuries after prolonged prone position ventilation in patients with SARS-CoV-2: a case series. Arch Phys Med Rehabil 2021; 102(3): 359–362. https://doi.org/10.1016/j.apmr.2020.10.131 DOI: https://doi.org/10.1016/j.apmr.2020.10.131

Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis [serial online]. [cited 2020 Jun 30]. Available from: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa330/5811989 DOI: https://doi.org/10.1093/cid/ciaa330

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77(6):683–690. https://doi.org/10.1001/jamaneurol.2020.1127 DOI: https://doi.org/10.1001/jamaneurol.2020.1127

Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020; 227: 2251–2261. https://doi.org/10.1007/s00405-020-05965-1 DOI: https://doi.org/10.1007/s00405-020-05965-1

Iannaccone S, Castellazzi P, Tettamanti A, Houdayer E, Brugliera L, de Blasio F, et al. Role of rehabilitation department for adult Covid-19 patients: the experience of the San Raffaele Hospital of Milan. Arch Phys Med Rehabil 2020; 101(9): 1656–1661. https://doi.org/10.1016/j.apmr.2020.05.015 DOI: https://doi.org/10.1016/j.apmr.2020.05.015

Brugliera L, Spina A, Castellazzi P, Cimino P, Tettamanti A, Houdayer E, et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020; 52(4): jrm00046. https://doi.org/10.2340/16501977-2678

Pasqua F, Biscione GL, Crigna G, Gargano R, Cardaci V, Ferri L, et al. Use of functional independence measure in rehabilitation of inpatients with respiratory failure. Respir Med 2009; 103(3): 471–476. https://doi.org/10.1016/j.rmed.2008.09.007 DOI: https://doi.org/10.1016/j.rmed.2008.09.007

Alemanno F, Houdayer E, Parma A, Spina A, Del Forno A, Scatolini A, et al. COVID-19 cognitive deficits after respiratory assistance in the subacute phase: a COVID-rehabilitation unit experience. PLoS One 2021; 16(2): e0246590. https://doi.org/10.1371/journal.pone.0246590 DOI: https://doi.org/10.1371/journal.pone.0246590

Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Deriu MG, et al. Rehabilitative of COVID-19 patients with acute lower extremity

Ischemia and amputation. J Rehabil Med 2020; 52(9): jrm00094. https://doi.org/10.2340/16501977-2678 DOI: https://doi.org/10.2340/16501977-2678

Brugliera L, Spina A, Castellazzi P, Cimino P, Arcuri P, Negro A, et al. Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr 2020; 52(4): 1–4. https://doi.org/10.2340/16501977-2678 DOI: https://doi.org/10.1038/s41430-020-0664-x

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48(1): 16–31. https://doi.org/10.1093/ageing/afy169 DOI: https://doi.org/10.1093/ageing/afz046

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49(2): M85–M94. https://doi.org/10.1093/geronj/49.2.M85 DOI: https://doi.org/10.1093/geronj/49.2.M85

Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23(1): 56–62. https://doi.org/10.1136/jnnp.23.1.56 DOI: https://doi.org/10.1136/jnnp.23.1.56

Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6(4): 278–296. https://doi.org/10.1111/j.2044-8260.1967.tb00530.x DOI: https://doi.org/10.1111/j.2044-8260.1967.tb00530.x

Iannaccone S, Alemanno F, Houdayer E, Brugliera L, Castellazzi P, Cianflone D, et al. COVID-19 rehabilitation units are twice as expensive as regular rehabilitation units. J Rehabil Med 2020; 52(6): jrm00073. https://doi.org/10.2340/16501977-2704 DOI: https://doi.org/10.2340/16501977-2704

Bahat G, İlhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med 2016; 7(3): 220. https://doi.org/10.1016/j.eurger.2015.12.012 DOI: https://doi.org/10.1016/j.eurger.2015.12.012

Bone AE, Hepgul N, Kon S, Maddocks M. Sarcopenia and frailty in chronic respiratory disease. Chron Respir Dis 2017; 14(1): 85–99. https://doi.org/10.1177/1479972316679664 DOI: https://doi.org/10.1177/1479972316679664

Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Association between sarcopenia and cognitive impairment: a systematic review and meta-analysis. J Am Med Dir Assoc 2016; 17(12): 1164.e7–1164.e15. https://doi.org/10.1016/j.jamda.2016.09.013 DOI: https://doi.org/10.1016/j.jamda.2016.09.013

Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr 1997; 127 5 Suppl: 990S–991S. https://doi.org/10.1093/jn/127.5.990S DOI: https://doi.org/10.1093/jn/127.5.990S

Sayer AA, Syddall H, Martin H, Patel H, Baylis D, Cooper C. The developmental origins of sarcopenia. J Nutr Health Aging 2008; 12(7): 427–432. https://doi.org/10.1007/BF02982703 DOI: https://doi.org/10.1007/BF02982703

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 2020; 20(6): 363–374. https://doi.org/10.1038/s41577-020-0311-8 DOI: https://doi.org/10.1038/s41577-020-0311-8

Neufeldt CJ, Cerikan B, Cortese M, Frankish J, Lee JY, Plociennikowska A, et al. SARS-CoV-2 infection induces a pro-inflammatory cytokine response through cGAS-STING and NF-κB. Commun Biol 2022; 5(1): 1–15. https://doi.org/10.1038/s42003-021-02983-5 DOI: https://doi.org/10.1038/s42003-021-02983-5

Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, et al. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun 2020; 89: 594–600. https://doi.org/10.1016/j.bbi.2020.07.037 DOI: https://doi.org/10.1016/j.bbi.2020.07.037

Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry [serial online]. 2020 [cited 2020 Jun 30]. Available from: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30287-X/abstract DOI: https://doi.org/10.2139/ssrn.3601761

Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020; 7(6): 547–560. https://doi.org/10.1016/S2215-0366(20)30168-1 DOI: https://doi.org/10.1016/S2215-0366(20)30168-1

Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 2015; 43(5): 1121–1129. DOI: https://doi.org/10.1097/CCM.0000000000000882

Murray H, Grey N, Wild J, Warnock-Parkes E, Kerr A, Clark DM, et al. Cognitive therapy for post-traumatic stress disorder following critical illness and intensive care unit admission. Cogn Behav Ther [serial online]. [cited 2020 Oct 27];13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251252/ DOI: https://doi.org/10.1017/S1754470X2000015X

Kim NH, Kim HS, Eun CR, Seo JA, Cho HJ, Kim SG, et al. Depression is associated with sarcopenia, not central obesity, in elderly korean men. J Am Geriatr Soc 2011; 59(11): 2062–2068. https://doi.org/10.1111/j.1532-5415.2011.03664.x DOI: https://doi.org/10.1111/j.1532-5415.2011.03664.x

Hsu YH, Liang CK, Chou MY, Liao MC, Lin YT, Chen LK, et al. Association of cognitive impairment, depressive symptoms and sarcopenia among healthy older men in the veterans retirement community in southern Taiwan: a cross-sectional study. Geriatr Gerontol Int 2014; 14 Suppl 1: 102–108. https://doi.org/10.1111/ggi.12221 DOI: https://doi.org/10.1111/ggi.12221

Budui SL, Rossi AP, Zamboni M. The pathogenetic bases of sarcopenia. Clin Cases Miner Bone Metab Off J Ital Soc Osteoporos Miner Metab Skelet Dis 2015; 12(1): 22–26. https://doi.org/10.11138/ccmbm/2015.12.1.022 DOI: https://doi.org/10.11138/ccmbm/2015.12.1.022

Hallgren M, Herring MP, Owen N, Dunstan D, Ekblom Ö, Helgadottir B, et al. Exercise, physical activity, and sedentary behavior in the treatment of depression: broadening the scientific perspectives and clinical opportunities. Front Psychiatry [serial online]. 2016 [cited 2021 Mar 12];7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786540/ DOI: https://doi.org/10.3389/fpsyt.2016.00036

Chang KV, Hsu TH, Wu WT, Huang KC, Han DS. Is sarcopenia associated with depression? A systematic review and meta-analysis of observational studies. Age Ageing 2017; 46(5): 738–746. https://doi.org/10.1093/ageing/afx094 DOI: https://doi.org/10.1093/ageing/afx094

Published

2023-01-31

How to Cite

Iannaccone, S., Brugliera, L., Spina, A., Nocera, G., Tettamanti, A., Giordani, A., … Alemanno, F. (2023). Sarcopenia is a Frequent Disease in Sars-Cov-2 Infection. Journal of Rehabilitation Medicine - Clinical Communications, 6, jrmcc00089. https://doi.org/10.2340/jrmcc.v6.2222

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