Muscle involvement in SARS-CoV-2 infection
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Since the outbreak of the 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.

CK, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalized COVID-19 patients. Disease severity was classified as severe in case of ICU admission or mortality. COVID-19 patients were additionally compared to a historical group of hospitalized influenza patients.

-- 351 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 frequent male, had more comorbidities and more frequently a severe disease course.
-- Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of ICU admitted patients had CK levels greater than 1000 U/l compared to only 4.7% of ICU-admitted COVID-19 patients.

Conclusively, 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.

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