Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Abstract

Aim. Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. Methods. Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. Results. In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. Conclusions. For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.

Ultrasound for Non-invasive Assessment and Monitoring of Quadriceps Muscle Thickness in Critically Ill Patients With Acute Kidney Injury

“…In addition, DEXA is not feasible at the bedside and involves patient radiation exposure. Computed tomography (CT) has been recently used to assess muscle mass and its correlation with mortality in critically ill patients (16). Despite its excellent accuracy, CT is expensive, FIGURE 2 | Probability of discharge (dot green line) and of transferal to rehabilitation unit (solid red line) according to the degree of muscle wasting (x-axis).…”

Impact of Sarcopenia on Outcomes of Minimally Invasive Cardiac Surgery

“…(21) Among these, the PMA determined using CT is the most widely accepted tool for diagnosing sarcopenia (1,2,(12)(13)(14)(15), as PMA has been indicated to be the most powerful predictor of hospital stay among other parameters including lumbar muscle area, and thoracic muscle area. (21,22) Previous research indicates that preoperative sarcopenia defined using PMA was associated with poorer long-term outcomes after valve surgery through full sternotomy. (1,2,23) Sarcopenia can be used as one of the objective means for defining frailty (11), and the surgical outcomes of patients with frailty are inevitably poor.…”

Association Between Sarcopenia and Adverse Events Following Transcatheter Aortic Valve Implantation

“…Fifth, there is debate regarding the level at which the psoas area should be measured, with some authors using L4 as the reference level 42 . We measured at L3 given that skeletal muscle area has been reported to peak at this level 16 and L3 measurements are more commonly reported in the literature 8,43 . Sixth, freehand planimetry has the disadvantage of including intramuscular fat as part of the measured muscle area.…”

“…A validated method for quantifying sarcopenia is the measurement of psoas muscle area using cross-sectional computed tomography (CT) imaging 5 . Using psoas area as a surrogate measure, previous studies have demonstrated an association between sarcopenia and morbidity/mortality in patients with abdominal aortic aneurysm 6 , colorectal cancer 7 , and pulmonary embolism 8 . However, the literature on sarcopenia in patients undergoing TAVI is heterogenous in terms of the measurement of sarcopenia, with prevalence ranging from 21% -70% based on definitions used 9 .…”