Disease entity impacts muscle wasting in the ICU with COVID-19 patients losing muscle nearly twice as fast.

Journal: Scientific reports
Published Date: Jun 20, 2025

Abstract

Muscle loss in critically ill patients, particularly during prolonged ICU stays, poses significant challenges to recovery and long-term outcomes. ICU-acquired weakness (ICUAW) manifests as severe muscle depletion, correlating with illness severity and hospitalization duration. This study aims to characterize long-term muscle loss trajectories in ICU patients with acute respiratory distress syndrome (ARDS) due to COVID-19 and severe acute pancreatitis (AP) and to explore contributing factors to elevated muscle decay. Retrospective cohort study including 154 ICU patients, 100 individuals suffering from AP and 54 from COVID-19 ARDS, who underwent a minimum of three CT scans during hospitalization, totaling 988 assessments. Sequential segmentation of psoas muscle area (PMA) was performed, and relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan, was calculated. Bivariate and multivariate linear regression analyses were conducted to identify and evaluate the factors contributing to muscle loss. ICU patients experienced an average PMA decline of 46.0%, with a reduction of 41.8% observed in COVID-19 patients and 48.2% in AP patients. Notably, the long-term daily PMA loss was significantly greater in COVID-19 patients (1.88%) compared to AP patients (0.98%; p < 0.001). Linear regression analysis identified disease entity (p < 0.001), length of hospitalization (p < 0.001), and obesity as significant contributors to daily muscle deterioration. Patients admitted to the ICU for COVID-19 and severe AP can experience extreme muscle decay, reaching up to 48.2%. While decay rates vary considerably, COVID-19 patients experienced nearly twice the daily muscle loss compared to AP patients. Key factors contributing to muscle decay included disease entity, hospitalization duration, and obesity. These findings highlight the distinct impact of the underlying disease on muscle deterioration and emphasize the heightened risk for obese patients and those undergoing extended hospitalization.

Authors

  • Johannes Kolck
    Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. Johannes.kolck@charite.de.
  • Clarissa Hosse
    Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Uli Fehrenbach
    Department of Diagnostic and Interventional Radiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Nick L Beetz
    From the Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany (C.A.H., G.L.B., N.L.B., A.H., L.J.S., K.F., F.D., M.R., A.D.J.B., B.H., M.H., S.H., T.P.); Berlin Institute of Health (BIH), Berlin, Germany (C.A.H., N.L.B., L.J.S., T.P.); Faculty VI-Informatics and Media, Berliner Hochschule für Technik (BHT), Einstein Center Digital Future, Berlin, Germany (G.L.B., F.B.); Bayer AG, Medical Affairs and Pharmacovigilance, Integrated Evidence Generation & Business Innovation, Berlin, Germany (A.H.); Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany (S.S.); and Department of Urology, Otto-von-Guericke-University Magdeburg, Germany and PROURO, Berlin, Germany (H.C.).
  • Timo A Auer
    Department of Diagnostic and Interventional Radiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
  • Christian Pille
    Department of Anesthesiology and Intensive Care Medicine| CCM| CVK, Charité- Universitätsmedizin Berlin, Berlin, Germany.
  • Dominik Geisel
    Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.

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