Incidence of Skeletal Muscle Injury with SARS-CoV-2 Infection in Tertiary Care Hospitals in Qatar

Abstract

Background: SARS-CoV-2 can contribute to a number of neurological manifestations. 19.3% of patients with severe COVID-19 had evidence of marked skeletal muscle injury and 13.7% of patients with COVID-19 have high CK levels. Methodology: We retrospectively analyzed 413 COVID-19 patients. We reviewed electronic medical records and collected data. Skeletal muscle injury was defined as skeletal muscle pain and elevated serum creatine kinase level. The primary objective to determine the incidence of skeletal muscle injury in COVID-19 patients. Results: The most common risk factors were hypertension diabetes and obesity and neurological symptoms at onset of illness were myalgia. Multi-organ systems involvement including 47.8% had skeletal muscle injury, 15.7% had rhabdomyolysis, 36.7% had acute kidney injury, 27.5% had acute liver injury, 23.9% had acute myocardial injury. Discussion: In addition to respiratory system involvement, other extrapulmonary multiorgan systems involvement including skeletal muscle injury, acute kidney injury, acute liver injury, acute myocardial injury, rhabdomyolysis, acute heart failure, acute pancreatitis and post ICU critical illness neuromyopathy. SARSCoV- 2 may direct invade skeletal muscle, hematogenous dissemination, immunemediated skeletal muscles injury and inflammatory response with cytokine storm may lead to pathological changes in skeletal muscle tissue including muscle fiber proteolysis and fibrosis. Conclusion: Skeletal muscles injury with COVID-19 patient’s manifest as myalgia, generalized fatigue, myositis, rhabdomyolysis, dermatomyositis-like interferonopathy 1, immune-mediated necrotizing myopathy and respiratory failure. Further studies are requiring with focus on long term outcomes of skeletal muscles injury and benefits of using post COVID rehabilitation programs.