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

被引:29
作者
Fuchs, Georg [1 ,2 ,4 ]
Thevathasan, Tharusan [2 ,3 ]
Chretien, Yves R. [1 ,2 ]
Mario, Julia [1 ,2 ]
Piriyapatsom, Annop [2 ,3 ]
Schmidt, Ulrich [2 ,3 ,5 ]
Eikermann, Matthias [2 ,3 ,6 ]
Fintelmann, Florian J. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Dept Radiol, 55 Fruit St, Boston, MA 02114 USA
[2] Harvard Med Sch, 55 Fruit St, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, 55 Fruit St, Boston, MA 02114 USA
[4] Charite Univ Med Berlin, Dept Radiol, Charitepl 1, D-10117 Berlin, Germany
[5] Univ Calif San Diego, Dept Anesthesiol, 9500 Gilman Dr, La Jolla, CA 92093 USA
[6] Beth Israel Deaconess Med Ctr, HMFP, 330 Brookline Ave, Boston, MA 02215 USA
关键词
Lumbar skeletal muscle index; Extubation; Pneumonia; Adverse discharge disposition; Mortality; Hospital costs; SPONTANEOUS BREATHING TRIAL; CRITICAL-CARE MEDICINE; EXTUBATION FAILURE; RESPIRATORY MUSCLE; BODY-COMPOSITION; CYSTIC-FIBROSIS; SARCOPENIA; STRENGTH; SURGERY; ICU;
D O I
10.1016/j.jcrc.2017.10.033
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: To evaluate the effect of a skeletal muscle index derived from a routine CT image at the level of vertebral body L3 (L3SMI) on outcomes of extubated patients in the surgical intensive care unit. Materials and methods: 231 patients of a prospective observational trial (NCT01967056) who had undergone CT within 5 days of extubation were included. L3SMI was computed using semi-automated segmentation. Primary outcomes were pneumonia within 30 days of extubation, adverse discharge disposition and 30-day mortality. Secondary outcomes included re-intubation within 72 h, total hospital costs, ICU length of stay (LOS), post-extubation LOS and total hospital LOS. Outcomes were analyzed using multivariable regression models with a priori-defined covariates height, gender, age, APACHE II score and Charlson Comorbidity Index. Results: L3SMI was an independent predictor of pneumonia (aOR 0.96; 95% CI 0.941-0.986; P = 0.002), adverse discharge disposition (aOR 0.98; 95% CI 0.957-0.999; P = 0.044) and 30-day mortality (aOR 0.94; 95% CI 0.890-0.995; P = 0.033). L3SMI was significantly lower in re-intubated patients (P = 0.024). Secondary analyses suggest that L3SMI is associated with total hospital costs (P = 0.043) and LOS post-extubation (P = 0.048). Conclusion: The lumbar skeletal muscle index, derived from routine abdominal CT, is an objective prognostic tool at the time of extubation. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:117 / 123
页数:7
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