Assessment of Muscle Function in Severe and Malnourished COVID-19 Patients

Abstract

COVID-19 is a disease at high risk of muscle failure and undernutrition. In this setting, systematic screenings are necessary to assess muscle deficit during hospitalization and after discharge. Objective: To analyze the interest of a self-assessment of muscle strength (SES) to evaluate the evolution of muscle strength during COVID-19 and to assess the agreement between SES and the handgrip test. Methods: Prospective cohort study including all inpatients diagnosed with COVID-19 admitted in a non-ICU unit, until the required number of subjects is reached. Handgrip test and SES were recorded at admission and every two days during hospitalization and at Day30 post-discharge. Sarcopenic screening test (SARC-F) and International Physical Activity Questionnaire (IPAQ-SF) were administered before admission and on Day30. Nutritional status was recorded at admission, at discharge and at Day30 post-discharge. Evolution effects were analyzed using ANOVA for repeated measures and Pearson's chi-square test (p< 0.05). Results: Handgrip and SES progression were significantly correlated (p=0.004), SES enabled detecting 95% of patients with progression in muscle strength. Muscle failure incidence was lower at discharge (73% to 42% for handgrip and 69% to 42% for SES (p=0.0035)). At admission, 61% had ≥30% reduction in food intake which was higher in the presence of anosmia and inflammation; 73% presented malnutrition and 19% necessitated tube feeding due to severe malnutrition as well as insufficient nutrition intake. Weight loss kinetics decreased significantly during hospitalization (-0.4±1.6% vs.-5.4±6.3% pre-admission, p=0.0016). At Day 30, 17% had a severe muscle failure (SES<7 and/or SARC-F>6) and 32% had persistent severe malnutrition. Conclusion: The present study showed that three quarters of COVID-19 patients admitted in a non-ICU setting presented malnutrition as well as sarcopenia as assessed by hand strength. Screening for malnutrition and muscle failure should be initiated immediately at the onset of care, with the aim of improving nutritional status as well as maintaining muscle mass and physical performance. During hospitalization, grip strength measured by a handheld dynamometer is inexpensive and easy to administer, even in a COVID unit. On the other hand, the 10-point verbal or visual analogue scales (SES) could prove useful in assessing the long-term progression of muscle strength.