Muscle involvement in SARS‐CoV‐2 infection

• Published in: European journal of neurology Vol. 28; no. 10; pp. 3411 - 3417
• Main Authors: Pitscheider, Lea, Karolyi, Mario, Burkert, Francesco R., Helbok, Raimund, Wanschitz, Julia V., Horlings, Corinne, Pawelka, Erich, Omid, Sara, Traugott, Marianna, Seitz, Tamara, Zoufaly, Alexander, Lindeck‐Pozza, Elisabeth, Wöll, Ewald, Beer, Ronny, Seiwald, Stefanie, Bellmann‐Weiler, Rosa, Hegen, Harald, Löscher, Wolfgang N.
• Format: Journal Article
• Language: English
• Published: Oxford John Wiley & Sons, Inc 01.10.2021; John Wiley and Sons Inc
• Subjects: Coronaviruses; COVID-19; Creatine; Creatine kinase; Demographic variables; Disease; hyperCKemia; Infections; Inflammation; Inflammatory response; Influenza; Intensive care; Kinases; Markers; Muscle and MNJ Disorders; Muscles; Myalgia; Original; Pandemics; Public health; Respiratory diseases; Serum levels; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Toxicity; Viral diseases; Viruses
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.14564

Background and Purpose Since the outbreak of the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) pandemic, several reports indicated neurological involvement in COVID‐19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia. Methods Creatine kinase, markers of inflammation, pre‐existing diseases and statin use were extracted from records of Austrian hospitalised COVID‐19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID‐19 patients were additionally compared to an historical group of hospitalised influenza patients. Results Three hundred fifty‐one patients with SARS‐CoV‐2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID‐19 and in 28% of influenza patients. CK was higher in severe COVID‐19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID‐19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID‐19, and 35.7% of intensive care unit (ICU)‐admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU‐admitted COVID‐19 patients. Conclusions HyperCKemia occurs in a similar frequency in COVID‐19 and influenza infection. CK levels were lower in COVID‐19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus‐triggered inflammatory response or direct muscle toxicity. Creatine kinase (CK) levels were compared between mild and severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) and influenza cases. CK was higher in severe disease and higher in influenza as compared to COVID‐19. Although the mechanisms are yet unknown, it appears that SARS‐CoV‐2 is less myotoxic than the influenza virus.