J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 7, July 2023, pages 368-376

Radiologic Features of T10 Paravertebral Muscle Sarcopenia: Prognostic Factors in COVID-19

Figure 1. T10 paravertebral muscle group cross-sectional area (CSA) and skeletal muscle density (SMD) measurements.

Figure 2. Plotted ROC curve of T10-CSA for hospital survival prediction. ROC: receiver operating characteristic; CSA: cross-sectional area.

Figure 3. T10-CSA diagnostic accuracy flow chart. COVID-2019: coronavirus disease 2019; CSA: cross-sectional area.

**Table 1.** Study Population Characteristics
	All (n = 84)	Survivors (n = 66)	Deceased (n = 18)	P value
IQR: interquartile range; CSA: cross-sectional area; SMD: skeletal muscle density; WBC white blood cell; PLTs: platelets; AST: aspartate aminotransferase; ALT: alanine aminotransferase; CRP: C-reactive protein; LDH: lactate dehydrogenase.
Male, n (%)	59 (70.2)	48 (72.7)	11 (61.1)	0.38
Age, median (IQR)	60 (47 - 71)	53 (41.5 - 68)	69 (60 - 77)	0.001
Symptoms onset (days)	7 (4 - 8)	7 (4 - 8)	5 (3 - 9)	0.58
CT severity score, median (IQR)	10 (6.25 - 15)	10 (5 - 13)	14 (9 - 19.5)	< 0.001
CT category, n (%)				< 0.001
Mild	22 (26.2)	21 (31.8)	1 (5.6)
Moderate	51 (60.7)	41 (62.1)	10 (55.6)
Severe	11 (13.1)	4 (6.1)	7 (38.9)
Sarcopenia radiologic features median (IQR)
T10-CSA (cm²)	16.705 (11.722 - 23.305)	18.24 (12.845 - 25.445)	11.91 (8.85 - 14.498)	<0.001
T10-SMD (HU)	29.750 (16.750 - 43.500)	29.375 (17.35 - 45.713)	34.1 (13.55 - 42.35)	0.82
Comorbidities (%)
CAD	4 (4.8)	3 (4.5)	1 (5.6)	0.88
Hypertension	20 (23.8)	15 (22.7)	5 (27.8)	0.75
Diabetes mellitus type 2	6 (7.1)	4 (6.1)	2 (11.1)	0.60
Dyslipidemia	10 (11.9)	7 (10.6)	3 (16.7)	0.68
Other metabolic comorbidity	8 (9.5)	6 (9.1)	2 (11.1)	1
Laboratory values median (IQR)
WBC (× 10³/µL)	5.265 (4.232 - 7.750)	5.085 (4.2 - 7.2)	7.42 (4.368 - 11.685)	0.08
PLTs (× 10³/µL)	188 (136 - 254.5)	190 (140 - 253.75)	183 (120 - 307)	0.96
Fibrinogen (mg/dL)	463 (363 - 539.5)	433.5 (349.25 - 540.25)	508 (456 - 532.5)	0.08
D-dimers (µg/mL)	0.465 (0.298 - 1.103)	0.465 (0.297 - 1.214)	0.465 (0.344 - 0.853)	0.86
Ferritin (mg/L)	364.5 (151.9 - 731.9)	367.5 (151.9 - 722.4)	336.5 (147.25 - 1,050.5)	0.92
AST (U/L)	25 (20 - 37.5)	25 (17.4 - 25)	25 (17.6 - 25)	0.45
ALT (U/L)	23 (15 - 41.23)	23.5 (16 - 41.9)	17 (12 - 41)	0.25
CRP (mg/L)	3.415 (1.11 - 10.92)	2.67 (1.03 - 8.45)	5.7 (2.7 - 14.1)	0.05
Creatinine (mg/dL)	0.9 (0.79 - 1.035)	0.92 (0.8 - 1.02)	0.9 (0.66 - 1.25)	0.84
Urea (mg/mL)	34 (25.7 - 40.05)	33.4 (24.5 - 39)	38 (33 - 56)	0.38
LDH (U/L)	265.5 (195.75 - 356.25)	260 (181 - 338)	319 (255 - 377)	0.022
Albumin (g/dL)	4.3 (3.87 - 4.6)	4.4 (3.99 - 4.62)	3.3 (2.95 - 3.98)	0.005
Invasive mechanical ventilation n (%)	15 (17.9)	5 (7.6)	10 (55.6)	< 0.001
Length of stay (days), median (IQR)	13.5 (8 - 21.25)	13 (7.5 - 19.5)	20 (10 - 28)	0.11

Table 1. Study Population Characteristics

All (n = 84)

Survivors (n = 66)

Deceased (n = 18)

P value

IQR: interquartile range; CSA: cross-sectional area; SMD: skeletal muscle density; WBC white blood cell; PLTs: platelets; AST: aspartate aminotransferase; ALT: alanine aminotransferase; CRP: C-reactive protein; LDH: lactate dehydrogenase.

Male, n (%)

59 (70.2)

48 (72.7)

11 (61.1)

0.38

Age, median (IQR)

60 (47 - 71)

53 (41.5 - 68)

69 (60 - 77)

0.001

Symptoms onset (days)

7 (4 - 8)

5 (3 - 9)

0.58

CT severity score, median (IQR)

10 (6.25 - 15)

10 (5 - 13)

14 (9 - 19.5)

< 0.001

CT category, n (%)

< 0.001

Mild

22 (26.2)

21 (31.8)

1 (5.6)

Moderate

51 (60.7)

41 (62.1)

10 (55.6)

Severe

11 (13.1)

4 (6.1)

7 (38.9)

Sarcopenia radiologic features median (IQR)

T10-CSA (cm²)

16.705 (11.722 - 23.305)

18.24 (12.845 - 25.445)

11.91 (8.85 - 14.498)

<0.001

T10-SMD (HU)

29.750 (16.750 - 43.500)

29.375 (17.35 - 45.713)

34.1 (13.55 - 42.35)

0.82

Comorbidities (%)

CAD

4 (4.8)

3 (4.5)

1 (5.6)

0.88

Hypertension

20 (23.8)

15 (22.7)

5 (27.8)

0.75

Diabetes mellitus type 2

6 (7.1)

4 (6.1)

2 (11.1)

0.60

Dyslipidemia

10 (11.9)

7 (10.6)

3 (16.7)

0.68

Other metabolic comorbidity

8 (9.5)

6 (9.1)

2 (11.1)

Laboratory values median (IQR)

WBC (× 10³/µL)

5.265 (4.232 - 7.750)

5.085 (4.2 - 7.2)

7.42 (4.368 - 11.685)

0.08

PLTs (× 10³/µL)

188 (136 - 254.5)

190 (140 - 253.75)

183 (120 - 307)

0.96

Fibrinogen (mg/dL)

463 (363 - 539.5)

433.5 (349.25 - 540.25)

508 (456 - 532.5)

0.08

D-dimers (µg/mL)

0.465 (0.298 - 1.103)

0.465 (0.297 - 1.214)

0.465 (0.344 - 0.853)

0.86

Ferritin (mg/L)

364.5 (151.9 - 731.9)

367.5 (151.9 - 722.4)

336.5 (147.25 - 1,050.5)

0.92

AST (U/L)

25 (20 - 37.5)

25 (17.4 - 25)

25 (17.6 - 25)

0.45

ALT (U/L)

23 (15 - 41.23)

23.5 (16 - 41.9)

17 (12 - 41)

0.25

CRP (mg/L)

3.415 (1.11 - 10.92)

2.67 (1.03 - 8.45)

5.7 (2.7 - 14.1)

0.05

Creatinine (mg/dL)

0.9 (0.79 - 1.035)

0.92 (0.8 - 1.02)

0.9 (0.66 - 1.25)

0.84

Urea (mg/mL)

34 (25.7 - 40.05)

33.4 (24.5 - 39)

38 (33 - 56)

0.38

LDH (U/L)

265.5 (195.75 - 356.25)

260 (181 - 338)

319 (255 - 377)

0.022

Albumin (g/dL)

4.3 (3.87 - 4.6)

4.4 (3.99 - 4.62)

3.3 (2.95 - 3.98)

0.005

Invasive mechanical ventilation n (%)

15 (17.9)

5 (7.6)

10 (55.6)

< 0.001

Length of stay (days), median (IQR)

13.5 (8 - 21.25)

13 (7.5 - 19.5)

20 (10 - 28)

0.11

**Table 2.** Logistic regression results on the impact of each variable on the odds of survival
	OR (95% CI)	P	Adjusted OR (95% CI)	P
Logistic regression coefficients with 95% CIs in parentheses (P < 0.05, two-tailed). The dependent variable is hospital discharge, i.e., survival. Univariate ORs are displayed on the first column. Variables with a P < 0.02 were included in the multivariate analysis. Adjusted ORs for all variables are displayed on the second column. OR: odds ratio; CI: confidence interval; CSA: cross-sectional area; MV: mechanical ventilation; CT-SS: computed tomography severity score; LDH: lactate dehydrogenase.
T10-CSA	1.195 (1.07 - 1.33)	0.002	1.207 (1.004 - 1.450)	0.045
MV	0.066 (0.018 - 0.241)	< 0.001	0.042 (0.004 - 0.403)	0.006
Age	0.934 (0.89 - 0.97)	0.003	0.896 (0.817 - 0.982)	0.019
CT-SS	0.836 (0.75 - 0.93)	< 0.001	0.844 (0.693 - 1.027)	0.089
LDH	0.993 (0.98 - 0.99)	0.016	0.997 (0.986 - 1.007)	0.546

Table 2. Logistic regression results on the impact of each variable on the odds of survival

OR (95% CI)

Adjusted OR (95% CI)

Logistic regression coefficients with 95% CIs in parentheses (P < 0.05, two-tailed). The dependent variable is hospital discharge, i.e., survival. Univariate ORs are displayed on the first column. Variables with a P < 0.02 were included in the multivariate analysis. Adjusted ORs for all variables are displayed on the second column. OR: odds ratio; CI: confidence interval; CSA: cross-sectional area; MV: mechanical ventilation; CT-SS: computed tomography severity score; LDH: lactate dehydrogenase.

T10-CSA

1.195 (1.07 - 1.33)

0.002

1.207 (1.004 - 1.450)

0.045

0.066 (0.018 - 0.241)

< 0.001

0.042 (0.004 - 0.403)

0.006

Age

0.934 (0.89 - 0.97)

0.003

0.896 (0.817 - 0.982)

0.019

CT-SS

0.836 (0.75 - 0.93)

< 0.001

0.844 (0.693 - 1.027)

0.089

LDH

0.993 (0.98 - 0.99)

0.016

0.997 (0.986 - 1.007)

0.546