BACKGROUND: Sarcopenia, defined by a loss of skeletal muscle mass and function, has been identified as a prevalent condition associated with poor clinical outcome among critically ill patients. This study aims to evaluate the impact of pre-existing sarcopenia on outcomes in critically ill patients with acute respiratory failure (ARF) due to COVID-19. MATERIAL AND METHODS: A retrospective study was carried out on COVID-19 patients admitted to intensive care. Pre-existing sarcopenia was assessed using early CT scans. Clinical outcomes, including duration of high-flow oxygenation (HFO), mechanical ventilation (MV), length of hospital stay (LOS) and ICU mortality, were evaluated according to sarcopenia status. RESULTS: Among the studied population, we found a high prevalence (75 patients, 50%) of pre-existing sarcopenia, predominantly in older male patients. Pre-existing sarcopenia significantly impacted HFO duration (6.8 (+/-4.4) vs. 5 (+/-2.9) days
p=0.005) but did not significantly affect MV requirement (21 (28%) vs. 23 (37.3%)
p=185), MV duration (7 vs. 10 days
p=0.233), ICU mortality (12 (16%) vs. 10 (13.3 %)
p=0.644) or hospital LOS (27 vs. 25 days
p=0.509). No differences in outcomes were observed between sarcopenic and non-sarcopenic obese patients. CONCLUSIONS: Pre-existing sarcopenia in critically ill COVID-19 patients is associated with longer HFO duration but not with other adverse outcomes. Further research is needed to elucidate the mechanisms and broader impact of sarcopenia on septic critically ill patient outcomes.