Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID‐19: a prospective observational study

  1. Saulo Gil
  2. Wilson Jacob Filho
  3. Samuel Katsuyuki Shinjo
  4. Eduardo Ferriolli
  5. Alexandre Leopold Busse
  6. Thiago Junqueira Avelino‐Silva
  7. Igor Longobardi
  8. Gersiel Nascimento de Oliveira Júnior
  9. Paul Swinton
  10. Bruno Gualano
  11. Hamilton Roschel
  12. The HCFMUSP COVID‐19 Study Group

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Abstract

Background

Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID‐19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID‐19 patients.

Methods

We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS‐CoV‐2 during hospitalization and were excluded from the analyses.

Results

The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m 2 . The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07–2.03; P  = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex‐specific mean and standard deviation (1.23 [95% CI: 1.06–1.43; P  = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross‐sectional area. The crude HR identified shorter hospital stay for patients with greater sex‐specific standardized values (1.20 [95% CI: 1.03–1.39; P  = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross‐sectional area (0.63 [95% CI: 0.46–0.88; P  = 0.006). Mean LOS for the patients with the lowest muscle cross‐sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross‐sectional area remained consistent and statistically significant after adjusting for other covariates.

Conclusions

Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID‐19, which stresses the value of muscle health in prognosis of this disease.

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  1. Version published to 10.1002/jcsm.12789
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    SciScore for 10.1101/2021.03.30.21254578: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the local Ethics Committee (Ethics Committee Approval Number (31303720.7.0000.0068).
    Consent: All patients provided written informed consent before entering the study.
    Randomizationnot detected.
    BlindingCross-sectional area analyses were performed in a blinded fashion by a single investigator using ImageJ (NIH, USA).
    Power Analysisnot detected.
    Sex as a biological variableThe outcome (LOS) was analyzed with multivariable Cox proportional baseline hazard models and adjusted for sex (male or female), age group (18-35, 36-55 or ≥ 56), obesity (BMI<30 or BMI≥30), oxygen support at admission (0-4L, 5-9L, ≥10L) and Type 2 diabetes (yes or no).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Cross-sectional area analyses were performed in a blinded fashion by a single investigator using ImageJ (NIH, USA).
    ImageJ
    suggested: (ImageJ, RRID:SCR_003070)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: First, the longitudinal design of this study does not allow causative conclusions. Second, although this study was adequately powered to detect changes in the selected outcomes, this was still a small cohort composed by patients with heterogeneous clinical features, medication regimen and disease manifestations, possibly subject to unmeasured confounders. While the Cox proportional hazards models were controlled for several potentially confound variables, direct sub-group comparisons were not possible due to sample size constraints. Third, our results are confined to patients with moderate to severe COVID-19 and should be read with care regarding other clinical settings. Finally, the minimal clinically important difference in LOS among patient with COVID-19 is yet unknown, which limits the ability to make clinical inferences about the present findings. Conclusions: Muscle strength and mass assessed on hospital admission are predictors of LOS in patients with COVID-19. While it is unknown whether these muscular parameters add to the prognostic value provided by the more established and accepted predictors that already have been identified 23, the present data suggest that muscle health may benefit patients with moderate to severe COVID-19. The evidence provided by this study paves the way for randomized controlled trials to test the utility of preventive or in-hospital interventions in shortening LOS among these patients through improving muscle mass and/or functi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.03.30.21254578v1 on medRxiv