CT Scan-Derived Muscle, But Not Fat, Area Independently Predicts Mortality in COVID-19

Bakel, S.I.J. van; Gietema, Hester A.; Stassen, Patricia M.; Gosker, Harry R.; Gach, D.; Bergh, J.P. van den; Osch, Frits van; Schols, A.M.W.J.; Beijers, Rosanne J.H.C.G.

doi:10.1016/j.chest.2023.02.048

Cited by 4 publications

(4 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, the finding that there was no difference between groups for muscle quality (mean PMHU) is unexpected because previous research using third lumbar vertebra CT scans has reported lower mean Hounsfield units in patients with malnutrition than without 14,27 . Further, low PMA has been associated with mortality in hospitalized patients with COVID‐19, patients with pneumonia, and patients in the ICU 18–20 . Although not well studied, there are a variety of potential confounders that are thought to impact CT‐derived muscle size and quality measures, such as variations in scanner, tube voltage, patient positioning, use of contrast dye, edema, and patient geometry 23 .…”

Section: Discussionmentioning

confidence: 96%

“…14,27 Further, low PMA has been associated with mortality in hospitalized patients with COVID-19, patients with pneumonia, and patients in the ICU. [18][19][20] Although not well studied, there are a variety of potential confounders that are thought to impact CTderived muscle size and quality measures, such as variations in scanner, tube voltage, patient positioning, use of contrast dye, edema, and patient geometry. 23 Additionally, there is no one specific value but, rather, a range for Hounsfield units to determine muscle and fat, 28 which could cause tissue measures based on this unit to include more (or less) than just the target tissue.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, CT scans that include the pectoralis muscles were reported to be among the most common scan site in ICU patients 17 . The pectoralis muscle cross‐sectional area measured by CT scan has been associated with mortality in patients with lung disease, cancer, coronavirus disease 2019 (COVID‐19) infection, pneumonia, heart failure, and critical illness 18–21 . Combining insights from prior studies using lumbar CT scan muscle mass for nutrition assessment and studies documenting the association of pectoralis muscle mass with outcomes, we hypothesize that the pectoralis muscles of the chest are potential alternative regions for assessing muscularity by CT in patients in the ICU.…”

Section: Introductionmentioning

confidence: 97%

“…17 The pectoralis muscle cross-sectional area measured by CT scan has been associated with mortality in patients with lung disease, cancer, coronavirus disease 2019 (COVID-19) infection, pneumonia, heart failure, and critical illness. [18][19][20][21] Combining insights from prior studies using lumbar CT scan muscle mass for nutrition assessment and studies documenting the association of pectoralis muscle mass with outcomes, we hypothesize that the pectoralis muscles of the chest are potential alternative regions for assessing muscularity by CT in patients in the ICU. Although scans at this region of interest are commonly performed in clinical settings, there is little research surrounding the utility of pectoralis muscle measurements in nutrition assessment, and, as such, reference cut points for low muscularity using CT-derived measures of the pectoralis muscles…”

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Malnutrition and pectoralis muscle index in medical intensive care unit patients: A matched cohort study

Smith,

Vest,

Rovner

et al. 2024

J Parenter Enteral Nutr

View full text Add to dashboard Cite

BackgroundMuscle assessment is an important component of nutrition assessment. The Global Leadership Initiative on Malnutrition (GLIM) consortium recently underscored the need for more objective muscle assessment methods in clinical settings. Various assessment techniques are available; however, many have limitations in clinical populations. Computed tomography (CT) scans, obtained for diagnostic reasons, could serve multiple purposes, including muscle measurement for nutrition assessment. Although CT scans of the chest are commonly performed clinically, there is little research surrounding the utility of pectoralis muscle measurements in nutrition assessment. The primary aim was to determine whether CT‐derived measures of pectoralis major cross‐sectional area (PMA) and quality (defined as mean pectoralis major Hounsfield units [PMHU]) could be used to identify malnutrition in patients who are mechanically ventilated in an intensive care unit (ICU). A secondary aim was to evaluate the relationship between these measures and clinical outcomes in this population.MethodsA retrospective analysis was conducted on 33 pairs of age‐ and sex‐matched adult patients who are being mechanically ventilated in the ICU. Patients were grouped by nutrition status. Analyses were performed to determine differences in PMA and mean PMHU between groups. Associations between muscle and clinical outcomes were also investigated.ResultsCompared with nonmalnourished controls, malnourished patients had a significantly lower PMA (P = 0.001) and pectoralis major (PM) index (PMA/height in m2; P = 0.001). No associations were drawn between PM measures and clinical outcomes.ConclusionThese findings regarding CT PM measures lay the groundwork for actualizing the GLIM call to action to validate quantitative, objective muscle assessment methods in clinical settings.

show abstract

Section: Discussionmentioning

confidence: 96%