Lumbar skeletal muscle index derived from routine computed tomography exams predict adverse post-extubation outcomes in critically ill patients

Fuchs, Georg; Thevathasan, Tharusan; Chrétien, Yves; Mario, Julia; Piriyapatsom, Annop; Schmidt, Ulrich; Eikermann, Matthias

doi:10.1016/j.jcrc.2017.10.033

Cited by 24 publications

(16 citation statements)

References 41 publications

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“…The high prevalence of both low SMA and low SMD found in this study, as well as the increased mortality in these groups, are in line with other studies [17e19, 37,38]. Identifying these patients may improve risk-stratification and help guide treatments.…”

Section: Low Skeletal Muscle Area and -Densitysupporting

confidence: 90%

Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

et al. 2020

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Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2e4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n ¼ 739). Patients received protocolized nutrition with protein target 1.2e1.5 g/kg/ day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73e0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79e0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64e0.90 for 60-day mortality and HR 0.80, 95%CI 0.68e0.93 for 6month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.

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Section: Low Skeletal Muscle Area and -Densitysupporting

confidence: 90%

Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

et al. 2020

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“…All analyses were adjusted for age, APACHE II, and CCI. This is the first study that correlates the muscle mass with hospital costs and is in agreement with previous studies in terms of mortality [ 15 ].…”

Section: Discussionsupporting

confidence: 91%

“…Low skeletal muscle mass measured by CT scan has shown negative associations with a wide variety of clinical outcomes such as mortality, length of stay, health-care costs, and discharge disposition. However, as mentioned before, CT scan is not a suitable tool for the daily practice [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

ROUNDS Studies: Relation of OUtcomes with Nutrition Despite Severity—Round One: Ultrasound Muscle Measurements in Critically Ill Adult Patients

Martín¹,

Zelaya²,

Zepeda³

et al. 2018

Journal of Nutrition and Metabolism

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Malnutrition (undernutrition) encompasses low intake or uptake, loss of fat mass, and muscle wasting and is associated with worse outcomes. Ultrasound has been introduced in the intensive care unit as a tool to assess muscle mass. The aim of the present study is to explore the relation between initial muscle mass and mortality in adult patients admitted to the intensive care unit. Methods. Rectus femoris and vastus intermedius thicknesses were measured by B-mode ultrasound in adult patients at admission, along with demographic characteristics, illness severity, comorbidities, biochemical variables, treatments, and in-hospital mortality as main outcomes. Analysis was made comparing survivors versus nonsurvivors and finally using binary logistic regression with mortality as dependent variable. Results. 59 patients were included in the analysis, severity measured by sequential organ failure assessment (SOFA) score was greater in nonsurvivors (17 (7) versus 24 (10) and 3 (1–5) versus 7 (3–10), resp.). Also, muscle thickness was lower in the latter group (1.44 (0.59) cm versus 0.98 (0.3) cm). Logistic regression showed severity by SOFA score as a risk factor and muscle thickness as a protective factor for mortality. Conclusion. Muscle mass showed to be a protective factor despite severity of illness; there is much more work to do regarding interventions and monitoring in order to prevent or overcome low muscle mass at admission to the intensive care unit.

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“…The described results used the correction factor for female muscle size. 21,22 However, whether using the female correction factor, correcting for ideal body weight, 23 or not using any correction method, the effects of PMA over 6-month survival, ICU-free days, and hospital survival remained statistically significant; and the effect of PMA over disability at hospital discharge remained nonsignificant (e- Table 10).…”

Section: The Effect Of Sex On the Association Of Pma With Outcomesmentioning

confidence: 99%

ICU Admission Muscle and Fat Mass, Survival, and Disability at Discharge

Jaitovich

Khan

Itty

et al. 2019

Chest

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BACKGROUND: Skeletal muscle dysfunction occurring as a result of ICU admission associates with higher mortality. Although preadmission higher BMI correlates with better outcomes, the impact of baseline muscle and fat mass has not been defined. We therefore investigated the association of skeletal muscle and fat mass at ICU admission with survival and disability at hospital discharge. METHODS: This single-center, prospective, observational cohort study included medical ICU (MICU) patients from an academic institution in the Unites States. A total of 401 patients were evaluated with pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) determinations conducted by CT scanning at the time of ICU admission, which were later correlated with clinical outcomes accounting for potential confounders. RESULTS: Larger admission PMA was associated with better outcomes, including higher 6month survival (OR, 1.03; 95% CI, 1.01-1.04; P < .001), lower hospital mortality (OR, 0.96; 95% CI, 0.93-0.98; P < .001), and more ICU-free days (slope, 0.044 AE 0.019; P ¼ .021). SAT was not significantly associated with any of the measured outcomes. In multivariable analyses, PMA association persisted with 6 months and hospital survival and ICU-free days, whereas SAT remained unassociated with survival or other outcomes. PMA was not associated with regaining of independence at the time of hospital discharge (OR, 0.99; 95% CI, 0.98-1.01; P ¼ .56). CONCLUSIONS: In this study cohort, ICU admission PMA was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes.

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Lumbar skeletal muscle index derived from routine computed tomography exams predict adverse post-extubation outcomes in critically ill patients

Cited by 24 publications

References 41 publications

Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density

ROUNDS Studies: Relation of OUtcomes with Nutrition Despite Severity—Round One: Ultrasound Muscle Measurements in Critically Ill Adult Patients

ICU Admission Muscle and Fat Mass, Survival, and Disability at Discharge

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