Abstract
Introduction: The diaphragm is the main muscle of inspiration, and its dysfunction contributes to adverse clinical outcomes in critically ill patients. We recently reported the infiltration of SARS-CoV-2, and the development of fibrosis, in the diaphragm of critically ill patients with COVID-19. In the current study, we aimed to characterise myofiber structure in the diaphragm of critically ill patients with COVID-19.
Methods: Diaphragm muscle specimens were collected during autopsy from patients who died of COVID-19 in three academic medical centres in the Netherlands in April and May 2020 (n=27). We studied diaphragm myofiber gene expression and structure and compared the findings obtained to those of deceased critically ill patients without COVID-19 (n=10).
Results: Myofibers of critically ill patients with COVID-19 showed on average larger cross-sectional area (slow-twitch myofibers: 2441±229 vs 1571±309 µm 2 ; fast-twitch myofibers: 1966±209 vs 1225±222 µm 2 ). Four critically ill patients with COVID-19 showed extremely large myofibers, which were splitting and contained many centralised nuclei. RNA-sequencing data revealed differentially expressed genes involved in muscle regeneration.
Conclusion: Diaphragm of critically ill patients with COVID-19 has distinct myopathic features compared with critically ill patients without COVID-19, which may contribute to the ongoing dyspnoea and fatigue in the patients surviving COVID-19 infection.
Keywords: COVID-19; respiratory muscles.
【저자키워드】 COVID-19, respiratory muscles, 【초록키워드】 SARS-CoV-2, Gene Expression, fatigue, fibrosis, Autopsy, Clinical outcome, COVID-19 infection, Patient, critically ill patients, RNA-sequencing, differentially expressed gene, Dyspnoea, infiltration, Deceased, Diaphragm, Critically ill patient, dysfunction, average, specimen, myopathic, muscles, feature, cross-sectional area, splitting, nuclei, collected, died, involved, reported, the patient, Netherland, contribute, Myofiber, myofibers, with COVID-19, 【제목키워드】 Diaphragm, Critically ill patient, myopathic, feature,