Orsucci Daniele, Trezzi Michele, Anichini Roberto, Blanc Pierluigi, Barontini Leandro, Biagini Carlo, Capitanini Alessandro, Comeglio Marco, Corsini Paulo, Gemignani Federico, Giannecchini Roberto, Giusti Massimo, Lombardi Mario, Marrucci Elena, Natali Alessandro, Nenci Gabriele, Vannucci Franco, Volpi Gino
Unit of Neurology, San Jacopo Hospital, 51100 Pistoia, Italy.
Unit of Neurology, San Luca Hospital, 55100 Lucca, Italy.
J Clin Med. 2021 Apr 16;10(8):1734. doi: 10.3390/jcm10081734.
Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy's "first wave" was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on "severe" ( = 99) or "mild" ( = 232) outcomes. "Severe" disease is defined here as death and/or mechanical invasive ventilation, in contrast to "mild" patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10-1672 U/L, versus median, 82; range, 12-1499 U/L, = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a "severe" outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both "severe" and "mild" patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified.
来自亚洲的早期报告表明，肌肉酶肌酸磷酸激酶（CK/CPK）血清水平升高可能与COVID-19患者更严重的预后相关。这项单中心回顾性队列研究纳入了意大利“第一波”疫情期间连续收治的331例COVID-19患者，旨在验证这种关系，并评估可能的混杂因素（年龄、体重指数、性别和合并症）的作用。我们根据“严重”（n = 99）或“轻度”（n = 232）结局将队列分为两组。这里“严重”疾病定义为死亡和/或机械侵入性通气，与之相对的“轻度”患者是指无需侵入性通气即可存活出院的患者；后一组还可能包括接受无创通气治疗的患者。后来出现更严重结局的患者入院时CK水平更高（中位数为126；范围为10 - 1672 U/L，而轻度患者中位数为82；范围为12 - 1499 U/L，P = 0.01），且CK血症>200 U/L与更差的预后相关。回归分析证实，CK升高是“严重”结局的独立预测因素。CK血症通常是短暂的，大多数“严重”和“轻度”患者在住院期间会恢复正常。虽然尚未证实新型冠状病毒会直接感染随意肌，但在COVID-19病程中短暂的肌肉功能障碍很常见。这种新型冠状病毒对随意肌的影响确实需要阐明。
