Article Data

  • Views 1391
  • Dowloads 194

Original Research

Open Access

Effects of SARS-CoV-2 on changes in muscle mass and muscle strength in the intensive care unit setting: a single-center, unblinded, prospective study

  • Halil Cebeci1
  • Gunes Comba Cebeci2,*,
  • Ozgur Komurcu3
  • Fatma Ulger3

1Department of Anesthesiology and Reanimation, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey

2Department of Anesthesiology and Reanimation, Istanbul Eyüpsultan State Hospital, 34050 Istanbul, Turkey

3Department of Anesthesiology and Reanimation, Division of Intensive Care Unit, Faculty of Medicine, Ondokuz Mayıs University, 55270 Samsun, Turkey

DOI: 10.22514/sv.2023.043 Vol.19,Issue 6,November 2023 pp.112-120

Submitted: 17 February 2023 Accepted: 28 March 2023

Published: 08 November 2023

*Corresponding Author(s): Gunes Comba Cebeci E-mail:


The prevalence of sarcopenia increases in the intensive care unit (ICU) and critically ill patients. In this study, we aimed to evaluate the muscle mass and muscle strength changes in patients diagnosed with coronavirus disease 19 (COVID-19) pneumonia in the ICU setting using anthropometric and ultrasonographic measurements. A total of 30 patients with COVID-19 pneumonia hospitalized in the ICU between June 2021 and December 2021 were included in this single-center, unblinded, prospective study. Thigh circumference and muscle mass of the rectus femoris were measured and anthropometric and ultrasonographic examination were performed. The muscle strength was evaluated using the Medical Research Council (MRC) grading system in non-intubated patients. All measurements were recorded on Days 1, 7, 14, and 21. All patients were followed for 21 days. At the end of 21 days, the muscle mass of the right and left rectus femoris decreased by 47% and 52.8%, respectively based on ultrasonographic examination. In addition, the muscle mass of the right and left rectus femoris decreased by 25.3% and 25.4%, respectively based on anthropometric measurements. The muscle strength of the thigh of the lower limb was evaluated using the MRC scores and each parameter decreased by one unit: the muscle strength was 5/5 at the time of ICU admission, while it regressed to 3/5 at week 2 and 2/5 at week 3. Intensive care unit-acquired weakness (ICU-AW) may develop in critically ill patients with COVID-19 due to the disease itself or treatment methods. A special attention should be paid to accurately assess and treat ICU-AW in this patient population.


Intensive care unit; Muscle weakness; COVID-19; Sarcopenia; Muscle loss

Cite and Share

Halil Cebeci,Gunes Comba Cebeci,Ozgur Komurcu,Fatma Ulger. Effects of SARS-CoV-2 on changes in muscle mass and muscle strength in the intensive care unit setting: a single-center, unblinded, prospective study. Signa Vitae. 2023. 19(6);112-120.


[1] Alsharif W, Qurashi A. Effectiveness of COVID-19 diagnosis and management tools: a review. Radiography. 2021; 27: 682–687.

[2] Azevedo RB, Botelho BG, Hollanda JVGD, Ferreira LVL, Junqueira de Andrade LZ, Oei SSML, et al. Covid-19 and the cardiovascular system: a comprehensive review. Journal of Human Hypertension. 2021; 35: 4–11.

[3] David OB, Idowu O, Adeloye OO, Tosin O. COVID-19: intensive care acquired weakness, a possible challenge in patient recovery? Middle East Journal of Applied Science & Technology. 2020; 3: 1–6.

[4] Soares MN, Eggelbusch M, Naddaf E, Gerrits KHL, van der Schaaf M, van den Borst B, et al. Skeletal muscle alterations in patients with acute Covid-19 and post-acute sequelae of Covid-19. Journal of Cachexia, Sarcopenia and Muscle. 2022; 13: 11–22.

[5] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020; 395: 497–506.

[6] Lang CH, Frost RA, Nairn AC, MacLean DA, Vary TC. TNF-α impairs heart and skeletal muscle protein synthesis by altering translation initiation. American Journal of Physiology-Endocrinology and Metabolism. 2002; 282: E336–E347.

[7] Rahiminezhad E, Zakeri MA, Dehghan M. Muscle strength/intensive care unit acquired weakness in COVID-19 and non-COVID-19 patients. Nursing in Critical Care. 2022. [Preprint].

[8] Hodgson CL, Tipping CJ. Physiotherapy management of intensive care unit-acquired weakness. Journal of Physiotherapy. 2017; 63: 4–10.

[9] Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Medicine. 2020; 46: 637–653.

[10] Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, De Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Critical Care Medicine. 2009; 37: S299–S308.

[11] Guidon AC, Amato AA. COVID-19 and neuromuscular disorders. Neurology. 2020; 94: 959–969.

[12] Yurdalan SU. Yoğun bakım ünitelerinde güncel fizyoterapi yaklaşımları. Clinical and Experimental Health Sciences. 2011; 1: 196–201.

[13] Qin ES, Hough CL, Andrews J, Bunnell AE. Intensive care unit-acquired weakness and the COVID-19 pandemic: a clinical review. PM&R. 2022; 14: 227–238.

[14] Mourtzakis M, Parry S, Connolly B, Puthucheary Z. Skeletal muscle ultrasound in critical care: a tool in need of translation. Annals of the American Thoracic Society. 2017; 14: 1495–1503.

[15] KIZILARSLANOĞLU MC, HALİL MG. Yoğun bakımda sarkopeni. Türkiye Klinikleri Yoğun Bakım Özel Dergisi. 2017; 3: 109–114. (In Turkish)

[16] Perkisas S, Brockhattingen K, Welch C, Bahat G. Using ultrasound in the assessment of muscle. European Journal of Geriatrics and Gerontology. 2021; 3: 1–3.

[17] Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Medicine. 2013; 11: 137.

[18] Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. GeroScience. 2020; 42: 1547–1578.

[19] Schefold JC, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. Journal of Cachexia, Sarcopenia and Muscle. 2010; 1: 147–157.

[20] Piva S, Fagoni N, Latronico N. Intensive care unit-acquired weakness: unanswered questions and targets for future research. F1000Research. 2019; 8: 508.

[21] Puthucheary ZA, Phadke R, Rawal J, McPhail MJ, Sidhu PS, Rowlerson A, et al. Qualitative ultrasound in acute critical illness muscle wasting. Critical Care Medicine. 2015; 43: 1603–1611.

[22] Mayer KP, Thompson Bastin ML, Montgomery-Yates AA, Pastva AM, Dupont-Versteegden EE, Parry SM, et al. Acute skeletal muscle wasting and dysfunction predict physical disability at hospital discharge in patients with critical illness. Critical Care. 2020; 24: 637.

[23] Bunnell A, Ney J, Gellhorn A, Hough CL. Quantitative neuromuscular ultrasound in intensive care unit-acquired weakness: a systematic review. Muscle & Nerve. 2015; 52: 701–708.

[24] Seddon H. Medical research council: aids to the exam of the peripheral nervous system. 1st ed. Her Majesty’s Stationery Office: London. 1976.

[25] Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). 1st ed. StatPearls Publishing: Treasure Island (FL). 2023.

[26] Rimmelé T, Pascal L, Polazzi S, Duclos A. Organizational aspects of care associated with mortality in critically ill COVID-19 patients. Intensive Care Medicine. 2021; 47: 119–121.

[27] Lewnard JA, Liu VX, Jackson ML, Schmidt MA, Jewell BL, Flores JP, et al. Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study. BMJ. 2020; 369: m1923.

[28] Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, et al. An official American thoracic society clinical practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. American Journal of Respiratory and Critical Care Medicine. 2014; 190: 1437–1446.

[29] Nagae M, Umegaki H, Yoshiko A, Fujita K. Muscle ultrasound and its application to point-of-care ultrasonography: a narrative review. Annals of Medicine. 2023; 55: 190–197.

[30] Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. JAMA. 2020; 324: 1307–1316.

[31] de Andrade-Junior MC, de Salles ICD, de Brito CMM, Pastore-Junior L, Righetti RF, Yamaguti WP. Skeletal muscle wasting and function impairment in intensive care patients with severe COVID-19. Frontiers in Physiology. 2021; 12: 640973.

[32] Agrawal A, Rathor R, Kumar R, Suryakumar G, Ganju L. Role of altered proteostasis network in chronic hypobaric hypoxia induced skeletal muscle atrophy. PLOS ONE. 2018; 13: e0204283.

[33] Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Critical Care. 2020; 24: 198.

[34] Jeschke MG, Gauglitz GG, Kulp GA, Finnerty CC, Williams FN, Kraft R, et al. Long-term persistance of the pathophysiologic response to severe burn injury. PLOS ONE. 2011; 6: e21245.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time