Muscle Radiodensity Reduction in COVID-19 Survivors Is Independent of NLR Levels During Acute Infection Phase

Mônica Aparecida Prata Alves, Fabiana Lascala Juliani, Beatriz Rafaelle Goes-Santos, Maria Carolina Santos Mendes, Mônica Corso Pereira, José Barreto Campello Carvalheira and Lígia M. Antunes-Correa ()
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Mônica Aparecida Prata Alves: Department of Adapted Physical Activity Studies (DEAFA), School of Physical Education, University of Campinas (FEF/UNICAMP), Campinas 13083-851, Brazil
Fabiana Lascala Juliani: Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, University of Campinas (FCM/UNICAMP), Campinas 13083-888, Brazil
Beatriz Rafaelle Goes-Santos: Department of Adapted Physical Activity Studies (DEAFA), School of Physical Education, University of Campinas (FEF/UNICAMP), Campinas 13083-851, Brazil
Maria Carolina Santos Mendes: Department of Internal Medicine, School of Medical Sciences, University of Campinas (FCM/UNICAMP), Campinas 13083-888, Brazil
Mônica Corso Pereira: Department of Pulmonology, School of Medical Sciences, University of Campinas (FCM/UNICAMP), Campinas 13083-888, Brazil
José Barreto Campello Carvalheira: Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, University of Campinas (FCM/UNICAMP), Campinas 13083-888, Brazil
Lígia M. Antunes-Correa: Department of Adapted Physical Activity Studies (DEAFA), School of Physical Education, University of Campinas (FEF/UNICAMP), Campinas 13083-851, Brazil

IJERPH, 2025, vol. 22, issue 4, 1-12

Abstract: COVID-19 survivors often experience late symptoms, possibly secondary to an exacerbated inflammatory response. This study aimed to investigate whether inflammatory levels, assessed by the neutrophil-to-lymphocyte ratio (NLR) during hospitalization in the acute phase of SARS-CoV-2 infection, affect the skeletal muscle phenotype and adipose tissue of COVID-19 survivors during outpatient follow-up after discharge. This retrospective, single-center study included COVID-19 survivors hospitalized from March 2020 to April 2021, who attended outpatient follow-ups 3 to 9 months after discharge. Patients were divided into two groups based on inflammatory levels during hospitalization: (1) low NLR (≤4.2) and (2) high NLR (>4.2). The skeletal muscle phenotype and adipose tissue were assessed using computed tomography. The study included 60 patients: 20 low NLR and 40 high NLR. The high NLR group was unexpectedly younger, but had longer hospital stays and required more intensive care. We observed a reduction in skeletal muscle radiodensity and an increase in skeletal muscle fat in both groups. However, we observed no differences in subcutaneous and visceral adipose tissue between hospitalization and follow-up. We conclude that COVID-19 survivors show reduced skeletal muscle radiodensity and increased skeletal muscle fat infiltration post-hospitalization, regardless of NLR levels during acute infection. In addition, age and intramuscular fat infiltration during hospitalization are associated with reducing skeletal muscle radiodensity. This highlights the need for targeted rehabilitation to address long-term muscle effects and recovery.

Keywords: COVID-19 survivors; neutrophil-to-lymphocyte ratio; skeletal muscle radiodensity (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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