Covid-19-Associated Rhabdomyolysis: A Scoping Review.

BACKGROUND: SARS-CoV-2 infection ("Covid-19") and the hypoxemia that has attended some cases, may predispose to rhabdomyolysis. We sought to identify reported cases of Covid-19-associated rhabdomyolysis, examining concurrent risk factors (RFs) and mortality outcomes.

METHODS & MATERIALS: We searched PubMed for articles conveying individual-level information on Covid-19-associated rhabdomyolysis, published between January 2020 and July 2022, with an English language abstract. Two independent parties performed the search, then abstracted information on cases including rhabdomyolysis RFs and mortality.

RESULTS: 117 individual reported cases of Covid-19-associated rhabdomyolysis were identified, from 89 articles. 80 cases (68.4%) had at least one reported non-Covid-19 RF (i.e., not considering Covid-19 or hypoxemia). On average, 1.27 additional RFs were reported, including: age ≥65, metabolic syndrome features, hypothyroidism, previous rhabdomyolysis, hemoglobinopathy, trauma/compression, pregnancy, exertion, inborn errors of metabolism, concurrent (co-)infection, capillary leak syndrome, and selected rhabdomyolysis-associated medications. Concurrent RFs are understated, as many articles omitted comorbidities/medications. Of 109 cases with ascertainable survival status, 31 (28%) died.

CONCLUSION: Covid-19 and hypoxemia confer risk of rhabdomyolysis, but additional rhabdomyolysis RFs are commonly present. Mortality is substantial irrespective of presence of such RFs. Clinicians should be aware of Covid-19-associated rhabdomyolysis, and caution may be warranted in administering agents that may amplify rhabdomyolysis risk.