The effect of sarcopenia on prognosis and mortality of COVID-19 patients

INTRODUCTION and OBJECTIVE: In late 2019, a growing number of pneumonia cases began to appear in Wuhan, China's Hubei province. The cause has been described as a novel coronavirus type. It spread quickly, triggering an epidemic first in China and then throughout the world. WHO proclaimed it a pandemic and named it "COVID-19," which stands for coronavirus disease in 2019. The virus continues to affect the world in the first half of 2021, and effective treatment for COVID -19 has not yet been found. Thus, early detection of infection, ascertainment of prognostic factors, and avoidance of potentially modifiable factors are of great importance. This study aimed to assess the effects of sarcopenia, demographic characteristics, some laboratory parameters, and additional diseases on mortality and prognosis (hospitalization duration, intensive care need, oxygen/mechanical ventilation need) in COVID-19 patients hospitalized. MATERIAL and METHOD: Approval for the study was obtained from the Ankara Yıldırım Beyazıt University Faculty of Medicine Clinical Research Ethical Committee. The study included patients diagnosed with COVID -19 who were hospitalized in the departments and intensive care units of Ankara Atatürk City Hospital. By retrospectively scanning patient files, demographic information, comorbidities, laboratory values at the time of hospital admission, need for intensive care at the time of admission or during hospitalization, oxygen requirement status, total hospitalization period, and survival/non-survival status were recorded. CT Images taken before hospitalization and recorded in the HiCamp Image Server 3.2 system were examined. The muscle region entering the L1 vertebra segment was calculated without measuring the L1 vertebra (with RadiAnt DICOM Viewer 2020.2 program). Sarcopenia was described as men with a muscle area less than 110.4 cm2 and women with a muscle area less than 70.1 cm2. In statistical analysis, the "Independent Sample-t" test was used for numerical data with a normal distribution when comparing groups, the "Mann Whitney U" test for data that did not have a normal distribution, and the "Chi-square" test for ordinal and nominal data. The factors were evaluated using univariate and multivariate regression analyses. FINDINGS: The study was conducted with 1500 patients who were diagnosed with COVID-19 and met the study's inclusion criteria. The mean age of the patients was 58.8 (18-101). Male patients had a rate of 58.3%, while female patients had a rate of 41.7%. Sarcopenia was detected to be prevalent in the study population at 25.1 %, with in-hospital mortality at 25.9%. Sarcopenia and mortality were found to have a statistically significant relationship (p<0.001). Sarcopenia was also related to admission to intensive care and the need for invasive mechanical ventilation, all of which are prognostic indicators. The factors predicting long-term hospitalization were advanced age, low lymphocyte count, and high ferritin level. The factors predicting oxygen demand were high LDH, anaemia, and advanced age. Advanced age, sarcopenia, anaemia, increased LDH, high ferritin level, high d-dimer, coronary artery disease, respiratory system disease, and neurological diseases were all factors that predicted intensive care admission. Advanced age, sarcopenia, anaemia, high ferritin levels, CKD, and neurological disease are all factors that predict the need for invasive mechanical ventilation. Advanced age, anaemia, a high ferritin level, and CKD were also predictors of mortality. RESULT: Sarcopenia was found to be a significant predictor of mortality in patients with COVID-19 in this study. Additionally, advanced age, anaemia, a high ferritin level, and the presence of CKD were successful predictors of mortality. We believe that CT scanning for sarcopenia, which is commonly used to diagnose COVID-19, may be used to predict prognosis at the time of presentation. Keywords: Sarcopenia, COVID-19, Mortality, Anaemia, Ferritin, LDH, Lymphocyte, D-dimer