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Acute muscle mass loss predicts long-term fatigue, myalgia, and health care costs in covid-19 survivors

  • Saulo Gil
    Affiliations
    Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Prof. Mello Moraes, 65 - São Paulo, SP, Brazil

    Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Gersiel Nascimento de Oliveira Júnior
    Affiliations
    Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Prof. Mello Moraes, 65 - São Paulo, SP, Brazil
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  • Flavia Mori Sarti
    Affiliations
    School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo, Brazil, SP, BR
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  • Wilson Jacob Filho
    Affiliations
    Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Igor Longobardi
    Affiliations
    Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Prof. Mello Moraes, 65 - São Paulo, SP, Brazil
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  • José Antonio Orellana Turri
    Affiliations
    School of Arts, Sciences and Humanities, University of São Paulo (USP), São Paulo, Brazil, SP, BR
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  • Samuel Katsuyuki Shinjo
    Affiliations
    Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Eduardo Ferriolli
    Affiliations
    Division of Internal and Geriatric Medicine, Department of Internal Medicine - Ribeirão Preto Medical School, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
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  • Thiago Junqueira Avelino-Silva
    Affiliations
    Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Alexandre Leopold Busse
    Affiliations
    Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Bruno Gualano
    Affiliations
    Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Prof. Mello Moraes, 65 - São Paulo, SP, Brazil

    Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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  • Hamilton Roschel
    Correspondence
    Corresponding author (to whom reprint requests should be addressed): Hamilton Roschel, PhD, Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR. Av. Dr. Arnaldo, 455 - Cerqueira Cesar - São Paulo, SP - Brasil, Postal code: 01246-903, Phone: + 55 11 3061.8789,
    Affiliations
    Applied Physiology & Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Prof. Mello Moraes, 65 - São Paulo, SP, Brazil

    Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Published:November 22, 2022DOI:https://doi.org/10.1016/j.jamda.2022.11.013
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      Abstract

      Objective

      We examined the impact of loss of skeletal muscle mass in post-acute sequelae of SARS-CoV-2 (PASC) infection, hospital readmission rate, self-perception of health, and health care costs in a cohort of COVID-19 survivors.

      Design

      Prospective observational study.

      Setting and Participants

      Tertiary Clinical Hospital. Eighty COVID-19 survivors aged 59±14 years were prospectively assessed.

      Methods

      Handgrip strength and vastus lateralis muscle cross-sectional area (CSAVL) were evaluated at hospital admission, discharge, and 6 months after discharge. PASC were evaluated 6 months after discharge (main outcome). Also, health care costs, hospital readmission rate, and self-perception of health were evaluated 2 and 6 months after hospital discharge. To examine whether the magnitude of muscle mass loss impacts the outcomes, we ranked patients according to relative CSAVL reduction during hospital stay into either “high muscle loss” (-18±11%) or “low muscle loss” (-4±2%) group, based on median values.

      Results

      High muscle loss group showed greater prevalence of fatigue (76% vs. 46%, P=0.0337) and myalgia (66% vs. 36%, P=0.0388), and lower muscle mass (-8% vs. 3%, P < 0.0001) than low muscle loss group 6 months after discharge. No between-group difference was observed for hospital readmission and self-perceived health (P>0.05). High muscle loss group demonstrated greater total COVID-19-related health care costs 2 ($77283.87 vs. $3057.14, P=0.0223, respectively) and 6 months ($90001.35 vs. $12913.27, P=0.0210, respectively) after discharge vs. low muscle loss group. Muscle mass loss was shown to be a predictor of total COVID-19-related health care costs at 2 (adjusted β=$10070.81, P<0.0001) and 6 months after discharge (adjusted β=$9885.63, P<0.0001).

      Conclusions and Implications

      COVID-19 survivors experiencing high muscle mass loss during hospital stay fail to fully recover muscle health. In addition, greater muscle loss was associated with a higher frequency of post-acute sequelae of SARS-CoV-2 and greater total COVID-19-related health care costs 2 and 6 months after discharge. Altogether, these data suggest that the loss of muscle mass resulting from COVID-19 hospitalization may incur in an economical burden to health care systems.

      Keywords