Relationship between myalgia and laboratory parameters in hospitalized patients with COVID-19

Year 2022, Volume: 12 Issue: 2, 306 - 311, 15.03.2022

Dilek Yılmaz Okuyan Meltem Karacan Gölen

https://doi.org/10.16899/jcm.1054978

Abstract

Aim: Myalgia is among the first and most common symptoms in patients with COVID-19. A limited number of studies have been found evaluating the frequency of myalgia and the laboratory findings associated with this condition. In this study, we aimed to evaluate the prevalence of myalgia and the relationship between myalgia and laboratory parameters in patients who were hospitalized due to COVID-19.
Material and Methods: Three hundred fifty-eight patients with confirmed diagnoses of COVID-19 who were hospitalized between March 2020 and January 2021 were included in the study. The patients were divided into two groups according to the presence and absence of myalgia. Demographic characteristics, medical history, symptoms, clinical findings, and laboratory findings were evaluated retrospectively.
Results: A total of 358 patients, 192 (42.9%) females and 166 males, were included in the study. The mean age of the patients was 60.3 ± 15.2 years. When the laboratory findings of the 166 patients with myalgia and 192 patients with no myalgia were compared, no difference was found between the groups in terms of white blood cell, neutrophil, lymphocyte, monocyte, and platelet counts, C-reactive protein, ferritin D-dimer, and troponin levels. However, creatine kinase (CK) levels were found to be significantly higher in the group with myalgia compared with the group without myalgia (p<0.001). In 92 (25.6%) of 358 patients, the CK level was found to be higher than 200 U/L. The median value for CK was 55 U/L in the group without myalgia and 221 U/L in the group with myalgia.
Conclusion: Myalgia is one of the most common symptoms in COVID-19. In patients with myalgia, the CK level is higher than in patients without myalgia. These patients should be closely monitored in terms of the risk of rhabdomyolysis because high CK is an indicator of muscle damage.

Keywords

COVID-19, creatine kinase, myalgia, rabdomiyoliz

Hospitalize Hastalarda Miyalji ve Laboratuar Parametreleri Arasındaki ilişki

Abstract

Amaç: COVID-19 hastalarında miyalji ilk ve en yaygın semptomlar arasında yer almaktadır. Miyalji sıklığını ve bu durumla ilişkili laboratuar bulgularını değerlendiren sınırlı sayıda çalışmaya rastlanılmıştır. Bu çalışmada hastalığı daha şiddetli olması sebebiyle hospitalize takip edilen hastalarda miyalji sıklığını ve miyalji ile laboratuar parametreleri arasındaki ilişkiyi değerlendirmeyi amaçladık.
Yöntem: Bu çalışmaya Mart 2020- Ocak 2021 tarihleri arasında hastanede yatırılarak takip edilen COVID-19 tanısı doğrulanmış 358 hasta dahil edilmiştir. Miyalji varlığı ve yokluğuna göre hastalar 2 gruba ayrılmıştır. Demografik özellikler, tıbbi geçmiş, semptomlar, klinik bulgular ve laboratuvar bulguları retrospektif olarak değerlendirildi.
Bulgular: Bu çalışmaya 192'si (% 42,9) kadın, 166’sı erkek olmak üzere toplam 358 hasta dahil edildi. Hastaların yaş ortalaması 60,3 ± 15,2 idi. Miyalji tarifleyen 166 hasta ve tariflemeyen 192 hastanın laboratuar bulguları karşılaştırıldığında, white blood cell (WBC), neutrophil, lymphocyte, monocyte, platelet değerleri, C reactive protein (CRP), ferritin D-dimer, troponin düzeyleri arasında gruplar arası fark saptanmadı. Ancak miyalji olan grupta olmayan gruba göre creatine kinase (CK) düzeyleri anlamlı yüksek saptandı (p<0.001). 358 hastanın 92’sinde (%25,6) CK düzeyi 200 U/L 'den yüksek saptanmıştır. CK için ortanca değer miyaljisi olmayan grupta 55 U/L iken miyaljisi olan grupta 221 U/L olarak elde edilmiştir.
Sonuç: COVID-19'da miyalji en sık gözlenen bulgulardan biridir. Miyalji tarifleyen hastalarda CK düzeyi miyalji olmayan hastalara göre yüksektir. CK yüksekliği kas hasarı göstergesi olduğundan bu hastalar rabdomiyoliz riski açısından yakın izlenmelidir.

Keywords

COVID-19, kreatin kinaz, miyalji, rabdomiyoliz

References

• 1. World Health Organization. Coronavirus disease 2019 (COVID-19) Dashboard 2020; 2020.
• 2. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683-690. doi: 10.1001/jamaneurol.2020.1127
• 3. Baig AM. Neurological manifestations in COVID-19 caused by SARS-CoV-2. CNS Neurosci Ther. 2020 May;26(5):499-501. doi: 10.1111/cns.13372.
• 4. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020 Jun;92(6):577-583. doi: 10.1002/jmv.25757.
• 5. Huang YH, Wu CY, Hsieh YW, Lin KC. Predictors of change in quality of life after distributed constraint-induced therapy in patients with chronic stroke. Neurorehabil Neural Repair. 2010 Jul-Aug;24(6):559-66. doi: 10.1177/1545968309358074.
• 6. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020 May 1;130(5):2620-2629. doi: 10.1172/JCI137244.
• 7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3.
• 8. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2251-2261. doi: 10.1007/s00405-020-05965-1.
• 9. World Health Organization. Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: interim guidance. 2020.
• 10. Hoong CWS, Amin MNME, Tan TC, Lee JE. Viral arthralgia a new manifestation of COVID-19 infection? A cohort study of COVID-19-associated musculoskeletal symptoms. Int J Infect Dis. 2021 Mar;104:363-369. doi: 10.1016/j.ijid.2021.01.031.
• 11. Escalera-Antezana JP, Lizon-Ferrufino NF, Maldonado-Alanoca A, Alarcón-De-la-Vega G, Alvarado-Arnez LE, Balderrama-Saavedra MA, et al; LANCOVID. Clinical features of the first cases and a cluster of Coronavirus Disease 2019 (COVID-19) in Bolivia imported from Italy and Spain. Travel Med Infect Dis. 2020 May-Jun;35:101653. doi: 10.1016/j.tmaid.2020.101653.
• 12. Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al; COVID-19 Task Force of YO-IFOS. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med. 2020 Sep;288(3):335-344. doi: 10.1111/joim.13089.
• 13. Cheng H, Wang Y, Wang GQ. Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. J Med Virol. 2020 Jul;92(7):726-730. doi: 10.1002/jmv.25785.
• 14. Su S, Cui H, Wang T, Shen X, Ma C. Pain: A potential new label of COVID-19. Brain Behav Immun. 2020 Jul;87:159-160. doi: 10.1016/j.bbi.2020.05.025.
• 15. Forcina L, Miano C, Scicchitano BM, Rizzuto E, Berardinelli MG, De Benedetti F, Pelosi L, et al. Increased Circulating Levels of Interleukin-6 Affect the Redox Balance in Skeletal Muscle. Oxid Med Cell Longev. 2019 Nov 16;2019:3018584. doi: 10.1155/2019/3018584.
• 16. Tang H, Pang S, Wang M, Xiao X, Rong Y, Wang H, et al. TLR4 activation is required for IL-17-induced multiple tissue inflammation and wasting in mice. J Immunol. 2010 Aug 15;185(4):2563-9. doi: 10.4049/jimmunol.0903664.
• 17. Reid MB, Li YP. Tumor necrosis factor-alpha and muscle wasting: a cellular perspective. Respir Res. 2001;2(5):269-72. doi: 10.1186/rr67.
• 18. Cipollaro L, Giordano L, Padulo J, Oliva F, Maffulli N. Musculoskeletal symptoms in SARS-CoV-2 (COVID-19) patients. J Orthop Surg Res. 2020 May 18;15(1):178.
• doi: 10.1186/s13018-020-01702-w. 19. Batur EB, Korez MK, Gezer IA, Levendoglu F, Ural O. Musculoskeletal symptoms and relationship with laboratory findings in patients with COVID-19. Int J Clin Pract. 2021 Jun;75(6):e14135. doi: 10.1111/ijcp.14135.
• 20. Keltz E, Khan FY, Mann G. Rhabdomyolysis. The role of diagnostic and prognostic factors. Muscles Ligaments Tendons J. 2014 Feb 24;3(4):303-12.
• 21. Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, Sánchez-Larsen Á, Layos-Romero A, García-García J, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology. 2020 Aug 25;95(8):e1060-e1070. doi: 10.1212/WNL.0000000000009937.
• 22. Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, et al. Muscle involvement in SARS-CoV-2 infection. Eur J Neurol. 2020 Sep 30:10.1111/ene.14564. doi: 10.1111/ene.14564.
• 23. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020 May 1;130(5):2202-2205. doi: 10.1172/JCI137647.
• 24. Zheng F, Tang W, Li H, Huang YX, Xie YL, Zhou ZG. Clinical characteristics of 161 cases of corona virus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci. 2020 Mar;24(6):3404-3410. doi: 10.26355/eurrev_202003_20711.
• 25. Karadaş Ö, Öztürk B, Sonkaya AR. A prospective clinical study of detailed neurological manifestations in patients with COVID-19. Neurol Sci. 2020 Aug;41(8):1991-1995. doi: 10.1007/s10072-020-04547-7.
• 26. Zhang X, Cai H, Hu J, Lian J, Gu J, Zhang S, et al. Epidemiological, clinical characteristics of cases of SARS-CoV-2 infection with abnormal imaging findings. Int J Infect Dis. 2020 May;94:81-87. doi: 10.1016/j.ijid.2020.03.040.
• 27. Webster JM, Fenton CG, Langen R, Hardy RS. Exploring the Interface between Inflammatory and Therapeutic Glucocorticoid Induced Bone and Muscle Loss. Int J Mol Sci. 2019 Nov 16;20(22):5768. doi: 10.3390/ijms20225768.