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Published on: December 11, 2016
Skeletal Muscle Manifestations and Creatine Kinase in COVID-19
Sarah A Friedman1,2, Zeinab Charmchi1, Michael Silver1
1Department of Neurology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Insights
Elevated creatine kinase (CK) levels in COVID-19 patients are linked to disease severity, including intensive care needs and mortality. However, CK was not associated with muscle symptoms or other lab values.
Area of Science:
- Biochemistry
- Infectious Diseases
- Critical Care Medicine
Background:
- Skeletal muscle symptoms and elevated creatine kinase (CK) are common in COVID-19.
- Previous research has not consistently linked CK levels to COVID-19 severity or outcomes.
- The relationship between CK and COVID-19 disease course requires further investigation.
Purpose of the Study:
- To determine if elevated CK is associated with severe COVID-19 requiring intubation, intensive care, or death.
- To explore the relationship between elevated CK and skeletal muscle symptoms.
- To assess the association between elevated CK and other laboratory markers.
Main Methods:
- Retrospective, single-center cohort study.
- Included 289 hospitalized patients with confirmed SARS-CoV-2 infection.
- Measured CK levels during admission between March 13, 2020, and May 13, 2020.
Main Results:
- 18.0% reported myalgia, 31.8% reported weakness, and 45.7% had elevated CK (>220 U/L).
- Elevated CK was significantly associated with COVID-19 disease severity, even after adjusting for C-reactive protein.
- No association was found between CK levels and skeletal muscle symptoms or other laboratory markers.
Conclusions:
- Elevated creatine kinase (CK) may be clinically significant in predicting COVID-19 disease trajectory.
- CK can serve as an additional biomarker for assessing COVID-19 severity.
- Further research is warranted to elucidate the role of CK in COVID-19 pathogenesis.
Background And Purpose:
Skeletal muscle symptoms and elevated creatine kinase (CK) levels have been consistently reported as part of the COVID-19 disease process. Previous studies have yet to show a consistent relationship between CK levels and skeletal muscle symptoms, disease severity, and death from COVID-19. The purpose of this study is to determine whether elevated CK is associated with a COVID-19 course requiring intubation, intensive care, and/or causing death. Secondary objectives: To determine if there is a relationship between elevated CK and (1) skeletal muscle symptoms/signs (2) complications of COVID-19 and (3) other diagnostic laboratory values.
Methods:
This is a retrospective, single center cohort study. Data were collected from March 13, 2020, to May 13, 2020. This study included 289 hospitalized patients with laboratory-confirmed SARS-CoV-2 and measured CK levels during admission.
Results:
Of 289 patients (mean age 68.5 [SD 13.8] years, 145 [50.2%] were men, 262 [90.7%] were African American) with COVID-19, 52 (18.0%) reported myalgia, 92 (31.8%) reported subjective weakness, and 132 (45.7%) had elevated CK levels (defined as greater than 220 U/L). Elevated CK was found to be associated with severity of disease, even when adjusting for inflammatory marker C-reactive protein (initial CK: OR 1.006 [95% CI: 1.002-1.011]; peak CK: OR 1.006 [95% CI: 1.002-1.01]; last CK: 1.009 [95% CI: 1.002-1.016]; q = .04). Creatine kinase was not found to be associated with skeletal muscle symptoms/signs or with other laboratory markers.
Conclusions:
Creatine kinase is of possible clinical significance and may be used as an additional data point in predicting the trajectory of the COVID-19 disease process.
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