Prognostic Implication of Baseline Sarcopenia for Length of Hospital Stay and Survival in Patients with Coronavirus Disease 2019

Kim, Ji-Won; Yoon, Jun Sik; Kim, Eun Jin; Hong, Hyo-Lim; Kwon, Hyun Hee; Jung, Chi Young; Kim, Kyung Chan; Sung, Yu Sub; Park, Sung-Hoon; Kim, Seong-Kyu; Choe, Jung-Yoon

BACKGROUND: The impact of sarcopenia on clinical outcomes of coronavirus disease 2019 (COVID-19) is not clearly determined yet. We aimed to investigate the association between baseline sarcopenia and clinical outcomes in patients with COVID-19. METHODS: All hospitalized adult patients with COVID-19 who had baseline chest computed tomography (CT) scans at a Korean university hospital from February 2020 to May 2020 were included. The main outcome was time from hospital admission to discharge. Death was considered as a competing risk for discharge. Baseline skeletal muscle cross-sectional area at the level of the 12th thoracic vertebra was measured from chest CT scans. The lowest quartile of skeletal muscle index (skeletal muscle cross-sectional area divided by height-squared) was defined as sarcopenia. RESULTS: Of 121 patients (median age, 62 years; 44 men; 29 sarcopenic), 7 patients died and 86 patients were discharged during the 60-day follow-up. Patients with sarcopenia showed a longer time to discharge (median, 55 vs. 28 days; p<0.001) and a higher incidence of death (17.2% vs. 2.2%; p=0.004) than those without sarcopenia. Baseline sarcopenia was an independent predictor of delayed hospital discharge (adjusted hazard ratio [aHR], 0.47; 95% CI, 0.23-0.96), but was not independently associated with mortality in patients with COVID-19 (aHR, 3.80; 95% CI, 0.48-30.26). The association between baseline sarcopenia and delayed hospital discharge was consistent in subgroups stratified by age, sex, comorbidities, and severity of COVID-19. CONCLUSION: Baseline sarcopenia was independently associated with prolonged hospital stay in patients with COVID-19. Sarcopenia could be a prognostic marker in COVID-19.