Respiratory Muscle Wasting Is Associated With Mortality in ICU COVID-19 Patients
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Pulmonary, Infection, Worldwide Data, 2022
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INTRODUCTION: We previously reported an association between respiratory muscle wasting (RMW) and outcomes in patients requiring invasive mechanical ventilation (MV) for acute respiratory failure. We hypothesized that RMW is also associated with poor outcomes in patients with severe COVID-19 infection.
METHODS: After obtaining institutional review board approval, all patients admitted to the medical intensive care unit (ICU), between March 2020 and December 2020, with laboratory confirmed COVID-19 and received chest computed tomography (CT) were retrospectively identified. Exclusion criteria included outside hospital transfers, patients who underwent major surgery, were pregnant, < 18 years of age, or had end stage liver disease. Respiratory skeletal muscle cross-sectional area was assessed at the 5th thoracic vertebral level using Slice-O-Matic® software. The area was used to calculate respiratory muscle index (RMI). Patients were divided into two groups, 1) the lowest gender-specific quartile of RMI and 2) second-fourth gender-specific RMI quartiles for comparative analysis.
RESULTS: Overall, 99 patients met inclusion criteria with a median BMI of 30.3 kg/m2 (IQR 25.4-34.8), age of 64 years (IQR 51-74), ICU admission sequential organ failure assessment (SOFA) score of 4 (IQR 3-6), and 67% (67/99) were male. High-dose corticosteroids were administered as part of institutional COVID-19 protocol in 60% (59/99). Overall, 43% (43/99) required invasive mechanical ventilation and 31% (31/99) expired during hospitalization. On univariate analysis, presence of respiratory muscle wasting (p=0.019) and reduced ICU admission platelet count (p=0.001) were found to be associated with in-hospital mortality. There was no difference in mortality when comparing gender, medical comorbidities, SOFA score, inflammatory markers, neutrophil-to-lymphocyte ratio, or COVID-19 targeted therapies. On multivariate logistic regression, patients with respiratory muscle wasting were significantly associated with in-hospital mortality when adjusting for admission platelet level (OR 3.3, 95% CI 1.02-10.46, p=0.047).
CONCLUSION: Presence of RMW in patients with severe COVID-19 infection is associated with in-patient mortality. Knowledge of this can help guide future research and risk stratification of critically ill COVID-19 patients.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Infection
Knowledge Area Worldwide Data
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Respiratory Failure
Tag Epidemiology Outcomes
Tag Mortality
Tag COVID-19
Tag Mechanical Ventilation
Year 2022
respiratory muscle wasting
severe COVID-19 infection
computed tomography imaging
patient outcomes
inpatient mortality


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