Elliot Bodofsky, MD
Milvia Y. Pleitez, MD
Frithiof R, Rostami E, Kumlien E, et al. Critical illness polyneuropathy, myopathy and neuronal biomarkers in COVID-19 patients: A prospective study. Clin Neurophysiol.
This article determines the risk factors for developing critical illness neuropathy (CIN) and/or myopathy (CIM) in 111 COVID patients admitted to an ICU in Sweden, as well as differences between COVID and non-COVID patients with ICU weakness. There were 14 COVID patients with ICU weakness, and 10 in the non-COVID group. All patients received upper and lower extremity nerve conduction testing, needle EMG, and blood tests for three biomarkers for neuronal injury. The biomarkers were also compared to a group of COVID ICU patients that did not develop weakness.
Of the 14 COVID ICU patients with weakness, 11 met the EMG/NCS criteria for CIN and/or CIM. All of the CIN/CIM patients were male (p=.01), and overall CIN/CIM COVID patients had a higher body mass index than those that did not (35 vs. 28, p=.006). CIN/CIM patients had a far longer stay in the ICU (27 days vs. 7) and a higher incidence of thromboembolic events, vasopressor support, and renal insufficiency. In fact, a majority of COVID patients intubated for more than 2 weeks developed CIN/CIM. Comparing COVID ICU weakness against non-COVID ICU weakness, COVID patients were more often male, and had a higher incidence of neuropathy, (CIN) but not CIM. All biomarkers for neuronal injury were higher in the COVID CIN/CIM group than non-CIN/CIM, and all correlated well with the degree of neuropathy seen on NCS.
This study shows that CIN/CIM is common in COVID patients that require prolonged intubation, those with more complications, and are male. Biomarkers for neuronal injury are good screening tests and correlate well with NCS. A limitation to this study was the modest number of patients with CIN/CIM. The article provides importance guidance on which COVID ICU patients are at risk for CIN/CIM, and patients that require evaluation.
Critical illness myopathy and polyneuropathy in Covid-19: Is it a distinct entity?Tankisi H.Clin Neurophysiol.