1
|
Elmorsi R, Camacho L, Krijgh DD, Tilney GS, Lyu H, Traweek RS, Witt RG, Roubaud MS, Roland CL, Mericli AF. Sarcoma Size and Limb Dimensions Predict Complications, Recurrence, and Death in Patients with Soft Tissue Sarcoma in the Thigh: A Multidimensional Analysis. Ann Surg Oncol 2024; 31:5421-5430. [PMID: 38520583 DOI: 10.1245/s10434-024-15183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Limb-sparing resections of thigh soft tissue sarcomas (STSs) can result in adverse outcomes. Identifying preoperative predictors for wound healing complications, tumor recurrence, and mortality is crucial for informed reconstructive decision-making. We hypothesized that preoperative measurements of thigh and tumor dimensions could serve as reliable indicators for postoperative complications, recurrence, and death. PATIENTS AND METHODS In this retrospective cohort study conducted from March 2016 to December 2021, we analyzed patients undergoing thigh STS excisions followed by reconstruction. Preoperative magnetic resonance imaging or computed tomography scans provided necessary thigh and tumor dimensions. Univariate and multivariate regression assessed relationships between these dimensions and postoperative outcomes, including complications, recurrence, and death. RESULTS Upon the analysis of 123 thighs, we found thigh width to be highly predictive of postoperative complications, even surpassing body mass index (BMI) and retaining significance in multivariate regression [odds ratio (OR) 1.19; 95% CI 1.03-1.39; p = 0.03]. Sarcoma-to-thigh width and thickness ratios predicted STS recurrence, with the thickness ratio retaining significance in multivariate regression (OR 1.03; 95% CI 1.001-1.05; p = 0.041). Notably, greater thigh thickness was independently protective against mortality in multivariate analysis (OR 0.80; 95% CI 0.65-0.98; p = 0.030). CONCLUSIONS Thigh width outperformed BMI in association with postoperative complications. This may create an opportunity for intervention, where weight loss can play a role during the neoadjuvant therapy period to potentially reduce complications. Sarcoma-to-thigh width and thickness ratios, particularly the latter, hold substantial predictive value in terms of STS recurrence. Moreover, thigh thickness is an independent predictor of survival.
Collapse
Affiliation(s)
- Rami Elmorsi
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis Camacho
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David D Krijgh
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gordon S Tilney
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lyu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Russell G Witt
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Margaret S Roubaud
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander F Mericli
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Bai W, Ge H, Han H, Xu J, Qin L. Association of frailty and sarcopenia with short-term mortality in older critically ill patients. J Nutr Health Aging 2024; 28:100321. [PMID: 39033576 DOI: 10.1016/j.jnha.2024.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/07/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND There is still no study on the use of the SARC-CalF questionnaire for older critically ill patients. Moreover, there is limited evidence on whether a combination of sarcopenia and frailty can provide incremental improvements in risk stratification for older critically ill patients. METHODS A total of 653 patients older than 60 years were recruited. We used the clinical frailty scale (CFS) and SARC-CalF questionnaire to assess the frailty status and sarcopenia risk, respectively, of older patients shortly after admission to the ICU. The effect of frailty and sarcopenia risk on ICU mortality and 30-day mortality was evaluated. RESULTS A total of 147 (22.5%) patients died in the ICU, and 187 (28.6%) patients died within 30 days after ICU admission. The CFS score was associated with increased ICU mortality [per 1-score increase: odds ratio (OR) = 1.222, 95% confidential interval (CI): 1.003-1.489] and 30-day mortality (per 1-score increase: OR = 1.307, 95% CI: 1.079-1.583). The SARC-CalF score was also associated with increased ICU mortality (per 1-score increase: OR = 1.204, 95% CI: 1.120-1.294) and 30-day mortality (per 1-score increase: OR = 1.247, 95% CI: 1.163-1.337). The addition of the CFS + SARC-CalF score to Acute Physiology and Chronic Health Evaluation (APACHE) II improved discrimination and reclassified ICU and 30-day mortality risk. CONCLUSIONS Sarcopenia risk assessed by the SARC-CalF questionnaire provided independent prognostic information for older critically ill patients. A combination of sarcopenia and frailty improved the prediction of mortality for older critically ill patients and thus might be useful in the clinical decision-making process.
Collapse
Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No.7 Weiwu Road, Jinshui District, Zhengzhou 463599, China
| | - Hongbo Ge
- Department of Ultrasound, The People's Hospital of Danyang, Danyang Hospital of Nantong University, Danyang, Jiangsu 212300, China
| | - Han Han
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No.7 Weiwu Road, Jinshui District, Zhengzhou 463599, China
| | - Juan Xu
- Department of General Surgery, Affiliated Xiaoshan Hospital, Hangzhou Normal University, No.728 Yucai Road, Xiaoshan District, Hangzhou 311202, China.
| | - Lijie Qin
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, No.7 Weiwu Road, Jinshui District, Zhengzhou 463599, China.
| |
Collapse
|
3
|
Zeng F, Jiang W, Chang X, Yang F, Luo X, Liu R, Lei Y, Li J, Pan C, Huang X, Sun H, Lan Y. Sarcopenia is associated with short- and long-term mortality in patients with acute-on-chronic liver failure. J Cachexia Sarcopenia Muscle 2024. [PMID: 38965993 DOI: 10.1002/jcsm.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND While sarcopenia is recognized as a predictor of mortality in cirrhosis, its influence on acute-on-chronic liver failure (ACLF) remains uncertain. Despite multiple studies examining the impact of sarcopenia on short-term mortality in patients with ACLF, the sample size of these studies was limited, and their outcomes were inconsistent. Therefore, this study aimed to explore the impact of sarcopenia on both short- and long-term mortality in patients with ACLF. METHODS This retrospective cohort study included 414 patients with ACLF that were treated between January 2016 and September 2022. Sarcopenia was diagnosed based on the measurement of the skeletal muscle index at the third lumbar vertebra (L3-SMI). Subsequently, the patients were divided into sarcopenia and non-sarcopenia groups. We analysed the basic clinical data of the two groups. Multivariate Cox proportional analysis was used to analyse short-term (28 days) and long-term (1 year and overall) mortality rates. RESULTS A total of 414 patients were included, with a mean age of 52.88 ± 13.41 years. Among them, 318 (76.8%) were male, and 239 (57.7%) had sarcopenia. A total of 280 (67.6%) patients died during the study period. Among them, 153 patients died within 28 days (37%) and 209 patients died within 1 year (50.5%). We found that the 28-day, 1-year and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (37% vs. 22.3%, P < 0.01; 50.5% vs. 34.9%, P < 0.01; and 67.6% vs. 53.1%, P < 0.01, respectively). Multivariate Cox regression analysis revealed that sarcopenia was significantly associated with increased mortality. The hazard ratios for sarcopenia were 2.05 (95% confidence interval [CI] 1.41-3.00, P < 0.01) for 28-day mortality, 1.81 (95% CI 1.29-2.54, P < 0.01) for 1-year mortality and 1.82 (95% CI 1.30-2.55, P < 0.01) for overall mortality. In addition, muscle density and international normalized ratio were associated with short- and long-term mortality. CONCLUSIONS Sarcopenia is associated with both short- and long-term mortality in patients with ACLF. Therefore, regular monitoring for sarcopenia is important for these patients.
Collapse
Affiliation(s)
- Fan Zeng
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Wei Jiang
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- Clinical Medicine School of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiujun Chang
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- Clinical Medicine School of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fuxun Yang
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaoxiu Luo
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Rongan Liu
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Yu Lei
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jiajia Li
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Chun Pan
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaobo Huang
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yunping Lan
- Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| |
Collapse
|
4
|
Zhang Y, Guo JY, Wang F, Li CW, Yu K. Start with muscle mass or muscle strength in diagnosis and management of sarcopenia? A systematic review of guidance documents. Asia Pac J Clin Nutr 2024; 33:247-271. [PMID: 38794984 PMCID: PMC11170015 DOI: 10.6133/apjcn.202406_33(2).0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/29/2024] [Accepted: 01/18/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Sarcopenia has garnered extensive attention in clinical practice since its high prevalence and significant impact on clinical outcomes. Multiple organizations have published guidance documents on sarcopenia, offering evidence-based recommendations for clinical practice and/or research. We aimed to appraise the methodological quality of the included documents and synthesize available recommendations for the screening, diagnosis, and intervention of sarcopenia. METHODS AND STUDY DESIGN We conducted a search on PubMed, Embase, Scopus, Cochrane Library, China National Knowledge Infrastructure, guideline database, and guideline organizations and professional societies websites for clinical practices, consensus statements and position papers in terms of sarcopenia, muscle atrophy or muscle loss published before April 17, 2023. The AGREE II instrument was used by three independent reviewers to assess the methodological quality of these documents. RESULTS Thirty-six guidance documents published between 2010 and 2023 were included. Seven documents fulfilled ≥ 50% of all the AGREE II domains. Seven underwent a Delphi process and six graded the strength of the recommendations. The process of screening (n=21), early diagnosis of sarcopenia (n=12), diagnosis of sarcopenia and severe sarcopenia (n=10), and management (n=21) were increasingly recommended. SARC-F (n=14) was the most recommended screening tool, and the assessment of muscle function was considered the first step in diagnosing sarcopenia. The management strategy for both age-related and disease-related sarcopenia mainly focused on exercise and nutrition intervention. CONCLUSIONS The guidance documents have provided referential recommendations that have great guiding significance. But the inconsistency in recommendations and variation in methodological rigour suggests that high-quality evidence is lacking yet.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Yu Guo
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun-Wei Li
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
5
|
Elmorsi R, Mericli AF. ASO Author Reflections: Leveraging Preoperative Measurements to Predict Postoperative Outcomes in Thigh Soft Tissue Sarcomas. Ann Surg Oncol 2024; 31:3705-3706. [PMID: 38553654 DOI: 10.1245/s10434-024-15242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Rami Elmorsi
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander F Mericli
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
6
|
Fan G, Zang B, Qiao Y, Shan T, Fu S, Xu W, Cai W, Jiang Y, Chao Y, Zhao W. Association of Sarcopenia, as Defined Based on the Skeletal Muscle Index, With Mortality and Morbidity After Cardiac Surgery: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:982-991. [PMID: 38350741 DOI: 10.1053/j.jvca.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate whether "sarcopenia," defined based on the preoperative skeletal muscle index (SMI), can predict major postoperative morbidity and all-cause mortality. DESIGN A retrospective observational cohort study. SETTING At the authors' Department of Critical Care Medicine. PARTICIPANTS A total of 986 adult Chinese patients underwent cardiac surgery (coronary artery bypass graft, valve surgery, combined surgery, or aortic surgery) between January 2019 and August 2022. MEASUREMENTS AND MAIN RESULTS The skeletal muscle area at the third lumbar level (L3) was measured via preoperative computed tomography (up to 3 months from the date of imaging to the date of surgery) and normalized to patient height (skeletal muscle index). Sarcopenia was determined based on the skeletal muscle index being in the lowest sex-specific quartile. The primary outcome was all-cause mortality. The secondary outcome was major morbidity. A total of 968 patients were followed for a median of 2.00 years, ranging from 1.06 to 2.90 years. After the follow-up, 76 patients died during the follow-up period. Multivariate Cox proportional analysis showed a relationship between sarcopenia (adjusted hazard ratio 1.80, 95% CI 1.04-3.11; p = 0.034) and all-cause mortality. Kaplan-Meier curves revealed a significantly lower survival rate in the sarcopenia group than in the nonsarcopenia group. Overall, 199 (20.6%) patients had major morbidity. Multivariate analysis showed a significant relationship between sarcopenia (adjusted odds ratio = 2.21, 95% CI 1.52∼3.22, p < 0.001) and major morbidity. CONCLUSIONS Sarcopenia, defined by the skeletal muscle index, is associated with all-cause mortality and major morbidity after cardiac surgery, thereby suggesting the need for perioperative sarcopenia risk assessment for patients undergoing cardiac surgery to guide the prevention and management of adverse outcomes.
Collapse
Affiliation(s)
- Guanglei Fan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Baohe Zang
- Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuhan Qiao
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tianchi Shan
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuyang Fu
- Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Xu
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wen Cai
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yaning Jiang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yali Chao
- Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenjing Zhao
- Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| |
Collapse
|
7
|
Yang Y, Chen WM, Wu SY, Zhang J. Persistence of analgesic usage and opioid consumption in sarcopenic patients undergoing neuraxial anesthesia: a nationwide retrospective cohort study. Pain Rep 2024; 9:e1129. [PMID: 38469029 PMCID: PMC10927332 DOI: 10.1097/pr9.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 03/13/2024] Open
Abstract
Introduction This study investigates the association between chronic postsurgical pain (CPSP) and long-term postsurgical analgesic usage in patients undergoing neuraxial anesthesia, with a specific focus on the presence or absence of sarcopenia. Objectives To assess the rate of analgesic prescription, including opioids, at 3 and 6 months postsurgery for patients with and without preoperative sarcopenia, and to determine the impact of sarcopenia on analgesic use after neuraxial anesthesia surgery. Methods Patients undergoing surgery under neuraxial anesthesia were categorized into sarcopenic and nonsarcopenic groups based on preoperative diagnosis using the ICD-10-CM code M62.84. Propensity score matching in a 1:4 ratio was applied for group matching. Analgesic prescription rates were evaluated at 3 and 6 months postsurgery, and multivariable logistic regression was used to analyze analgesic use, comparing patients with and without preoperative sarcopenia. Results Among 3805 surgical patients, 761 had sarcopenia, while 3044 did not. At 3 months postsurgery, 62.3% of sarcopenic patients received analgesics, with 2.9% receiving opioids, compared to 57.1% of nonsarcopenic patients receiving analgesics and 0.8% receiving opioids. At 6 months postsurgery, 30.8% of sarcopenic patients received analgesics (1.7% opioids), while 26.3% of non-sarcopenic patients received analgesics (0.3% opioids). Multivariable logistic regression analysis revealed that preoperative sarcopenia was significantly associated with higher analgesic prescription rates at both 3 months (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.05-1.53) and 6 months (aOR, 1.17; 95% CI, 1.07-1.42) postsurgery. Furthermore, sarcopenic patients exhibited significantly higher opioid prescription rates at 3 months (aOR, 1.11; 95% CI, 1.05-2.45) and 6 months (aOR, 1.89; 95% CI, 1.12-4.96) postsurgery. Conclusion Sarcopenia emerges as an independent risk factor for prolonged analgesic use after neuraxial anesthesia surgery and significantly elevates the risk of developing CPSP.
Collapse
Affiliation(s)
- Yitian Yang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
8
|
Choi MH, Kim D, Kim J, Song YG, Jeong SH. Shift in risk factors for mortality by period of the bloodstream infection timeline. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:97-106. [PMID: 38092626 DOI: 10.1016/j.jmii.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/30/2023] [Accepted: 11/30/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND This study was designed to determine changes in risk factors on the prognosis of patients during each period of the bloodstream infection (BSI) timeline. METHODS Through an integrated study of multivariable regressions with machine learning techniques, the risk factors for mortality during each period of BSI were analyzed. RESULTS A total of 302,303 inpatients who underwent blood cultures during 2011-2021 were enrolled. More than 8 % of BSI cases progressed to subsequent BSI, and risk factors were identified as gut colonization with vancomycin-resistant enterococci (aOR 1.82; 95 % CI 1.47-2.24), intensive care unit admission (aOR 3.37; 95 % CI 3.35-4.28), and current cancer chemotherapy (aOR 1.54; 95 % CI 1.36-1.74). The mean SOFA score of the deceased patients during the first 7 days was 10.6 (SD 4.3), which was significantly higher than those on days 8-30 (7.0 ± 4.2) and after Day 30 (4.0 ± 3.5). BSIs caused by Acinetobacter baumannii and Candida albicans were more likely to result in deaths of patients for all time periods (all, P < 0.001). BSIs caused by Enterococcus faecalis and Enterococcus faecium were associated with a poor outcome in the period after Day 30 (both, P < 0.001). Nonsusceptible phenotypes to β-lactam/β-lactamase inhibitors of Escherichia coli and Klebsiella pneumoniae influenced the prognoses of patients with BSI in terms of high mortality rates during both days 8-30 and after Day 30. CONCLUSION Influence of microbiological factors on mortality, including BSI-causative microorganisms and their major antimicrobial resistance, was emphasized in both periods of days 8-30 and after Day 30.
Collapse
Affiliation(s)
- Min Hyuk Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Jihyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea.
| |
Collapse
|
9
|
Chun SY, Cho YS, Kim HB. Association between reduced muscle mass and poor prognosis of biliary sepsis. Sci Rep 2024; 14:1857. [PMID: 38253616 PMCID: PMC10803318 DOI: 10.1038/s41598-024-52502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
Sepsis is a life-threatening disease, contributing to significant morbidity and mortality. This study aimed to investigate the association between low muscle mass and the prognosis of patients with biliary sepsis, focusing on outcomes such as length of hospital stay (LOS), intensive care unit (ICU) admission, and in-hospital mortality. This retrospective, single-center, observational study included adult patients with biliary sepsis who visited the emergency department between January 2016 and December 2021. Low muscle mass was assessed using the psoas muscle index (PMI). Using computed tomography imaging, the area of both sides of the psoas muscle at the L3 level was measured, and the PMI, corrected by the patient's height was calculated. The primary outcome was in-hospital mortality, and the secondary outcomes were intensive care unit (ICU) admission, LOS, and 14-day mortality. A total of 745 patients were included in this study. Low muscle mass was defined as a PMI < 421 mm2/m2 for males and < 268 mm2/m2 for females with the lower quartile of PMI according to sex. The cohort was classified into sarcopenic (n = 189) and non-sarcopenic (n = 556) groups. There was a significant association between low muscle mass and in-hospital mortality (odds ratio, 3.81; 95% confidence interval, 1.08-13.47; p < 0.001), while there was no significant association between low muscle mass and ICU admission. In addition, the median LOS in the sarcopenic group (10 [7-14] days) was significantly longer than the median (8 [6-11] days) in the non-sarcopenic group. Low muscle mass was significantly associated with clinical outcomes, particularly in-hospital mortality and LOS, in patients with biliary sepsis.
Collapse
Affiliation(s)
- Soh Yeon Chun
- Department of Emergency Medicine, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Han Bit Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
10
|
Zhang H, Wang J, Xi J, Xu J, Wang L. Functional fitness and risk factors of older patients with diabetes combined with sarcopenia and/or frailty: A cross-sectional study. Nurs Open 2024; 11:e2042. [PMID: 38214433 PMCID: PMC10697117 DOI: 10.1002/nop2.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 01/13/2024] Open
Abstract
AIM To learn the functional fitness levels in older adults with diabetes combined with sarcopenia and/or frailty. DESIGN A cross-sectional investigation study. METHODS A total of 205 participants with type 2 diabetes were recruited from September 2019 to August 2020. All patients underwent diagnostic screening for sarcopenia and frailty, and were divided into combined group (the patients who had sarcopenia and/or frailty) and non-combined group (the patient who had no sarcopenia and/or frailty). The diagnostic criteria for sarcopenia applied was proposed by the Asian Working Group on Sarcopenia in 2019 and frailty status was assessed using FRAIL Scale. Functional fitness was measured using the Senior Fitness Test and compared between combined and non-combined groups. Biochemical data of blood routine, glycolipid, and hepatorenal function tests were acquired from medical records. Logistic regression analysis was applied to explore the factors associated with the sarcopenia and/or frailty in the older adults with diabetes. RESULTS Compared with non-combined group, the participants in combined group exhibited shorter 6-min walk distance, fewer repetitions of arm curls and chair stands, smaller back scratch and chair sit-and-reach values, and longer time in the 8-ft up-and-go test. The patients in the combined group had significantly lower level of red blood cell, haemoglobin, haematocrit, and higher level of platelet and blood urea nitrogen. Apart from calf circumference, physical activity, and insulin injection treatment, 6-min walk distance was the factor associated with diabetes combined with sarcopenia and/or frailty.
Collapse
Affiliation(s)
- Hui Zhang
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
- School of NursingSuzhou Vocational Health CollegeSuzhouChina
| | - Jinping Wang
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
- Department of EndocrinologySubei People's Hospital of Jiangsu ProvinceYangzhouChina
| | - Jing Xi
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
| | - Jing Xu
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
| | - Li Wang
- School of NursingSuzhou Medical College of Soochow UniversitySuzhouChina
| |
Collapse
|
11
|
You Y, Wu S, Guo X, Chen M, Wang Y, Yu W. Acute muscle wasting rate assessment and long-term mortality in critically ill trauma. Asia Pac J Clin Nutr 2023; 32:417-425. [PMID: 38135477 PMCID: PMC11090393 DOI: 10.6133/apjcn.202312_32(4).0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/27/2023] [Accepted: 08/17/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the relationship between acute muscle wasting rate and long-term mortality in critically ill trauma. METHODS AND STUDY DESIGN A single-center, retrospective study was conducted in critically ill trauma. Patients with Computed Tomography scans including the L3 vertebra within 24 hours and at 1 week after trauma were recruited. Acute muscle wasting rate was defined as the mean percent variation per day of skeletal muscle index in the first week after trauma. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether acute muscle wasting rate could help predict hospital malnutrition and 1-year mortality. RESULTS Skeletal muscle index was 49.3±10.7 cm2/m2 at baseline and decreased to 45.1±9.6 cm2/m2 (p<0.001) at 1 week and 39.8±10.8cm2/m2 (p<0.001) at 1 month after trauma. A sustained decrease of skeletal muscle index was observed from baseline up to 6 months (33.7±8.4cm2/m2, p<0.001) post trauma, and lasted for 1 year (37.7±5.6cm2/m2, p=0.004). Logistic regression analysis showed that acute muscle wasting rate was an independent risk factor for hospital malnutrition and 1-year mortality. Every 1% absolute increase of acute muscle wasting rate was associated with 1.82-fold higher odds of 1-year mortality in critically ill trauma. The area under curve of acute muscle wasting rate was 0.813 for hospital malnutrition prediction and 0.715 for 1-year mortality prediction. CONCLUSIONS Acute muscle wasting rate was independently associated with higher 1-year mortality and hospital malnutrition in critically ill trauma.
Collapse
Affiliation(s)
- Yong You
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shuyun Wu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Xiaofang Guo
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ming Chen
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Wang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
12
|
Darden N, Sharma S, Wu X, Mancini B, Karamchandani K, Bonavia AS. Long-term clinical outcomes in critically ill patients with sepsis and pre-existing low muscle mass: a retrospective cohort study. BMC Anesthesiol 2023; 23:313. [PMID: 37715183 PMCID: PMC10503077 DOI: 10.1186/s12871-023-02274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Low muscle mass has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear. METHODS Retrospective cohort analysis of patients treated at a quaternary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with low muscle mass defined by [Formula: see text] 5th percentile skeletal muscle index, measured at the L3 lumbar level (L3SMI) on Computed-Tomography (CT) scan ([Formula: see text] 41.6 cm2/m2 for males and [Formula: see text] 32.0 cm2/m2 for females). L3SMI was calculated by normalizing the CT-measured skeletal muscle area to the square of the patient's height (in meters). Measurements were taken from abdominal/pelvic CT scan obtained within 7 days of sepsis onset. The prevalence of low muscle mass and its association with clinical outcomes, including in-hospital and one-year mortality, and post-hospitalization discharge disposition in survivors, was analyzed. Unfavorable post-hospitalization disposition was defined as discharge to a location other than the patient's home. RESULTS Low muscle mass was present in 34 (23%) of 150 patients, with mean skeletal muscle indices of 28.0 ± 2.9 cm2/m2 and 36.8 ± 3.3 cm2/m2 in females and males, respectively. While low muscle mass was not a significant risk factor for in-hospital mortality (hazard ratio 1.33; 95% CI 0.64 - 2.76; p = 0.437), it significantly increased one-year mortality after adjusting for age and illness severity using Cox multivariate regression (hazard ratio 1.9; 95% CI 1.1 - 3.2; p = 0.014). Unfavorable post-hospitalization discharge disposition was not associated with low muscle mass, after adjusting for age and illness severity in a single, multivariate model. CONCLUSION Low muscle mass independently predicts one-year mortality but is not associated with in-hospital mortality or unfavorable hospital discharge disposition in critically ill patients with sepsis.
Collapse
Affiliation(s)
- Nola Darden
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA
| | | | - Xue Wu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Kunal Karamchandani
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anthony S Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA.
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Penn State Milton S Hershey Medical Center, 500 University Dr, Mailbox H-187, Hershey, PA, 17033, USA.
| |
Collapse
|
13
|
Kaya V, Tahtabasi M, Akin Y, Karaman E, Gezer M, Kilicaslan N. Prognostic Value of Vertebral Bone Density in the CT Scans of Sepsis Patients Admitted to the Intensive Care Unit. J Clin Densitom 2023; 26:101417. [PMID: 37269790 DOI: 10.1016/j.jocd.2023.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
AIM To evaluate the prognostic value of vertebral bone mineral density (BMD) and its relationship with mortality using the computed tomography (CT) scans of sepsis patients admitted to the intensive care unit. METHODS In this retrospective study, patients diagnosed with sepsis at the intensive care unit between January and December 2022 were evaluated. Bone density was manually measured from the vertebral body using axial CT images. The relationship of clinical variables and patient outcomes with vertebral BMD, mortality, and mechanical ventilation was investigated. A lower BMD (osteoporosis) was defined as ≤100 HU. RESULTS The study included 213 patients (95 females, 44.6%). The mean age of all patients was 60.1±18.7 years. At least one comorbidity was present in 64.7% (n=138) of the patients, and the most common comorbidity was hypertension (n=73, 34.2%). The mortality rate was 21.1% (n=45), and the mechanical ventilation rate was 17.4% (n=37), both being statistically significantly higher among the patients with a lower BMD (36.4 vs. 12.9%; p<0.001 and 29.7 vs. 10.8%; p=0.001, respectively). The rate of a lower BMD was significantly higher in the mortality group (59.5 vs. 29.5%; p=0.001). In the regression analysis, a lower BMD [odds ratio (OR), 2.785; 95% confidence interval (CI): 1.231-6.346, p=0.014] was a significant independent predictor of mortality. Interobserver agreement for BMD measurement was excellent, with an intraclass correlation coefficient of 0.919 (95% CI: 0.904-0.951). CONCLUSION Vertebral BMD is a strong independent predictor of mortality and can be easily and reproducible evaluated on the thoracoabdominal CT images of patients admitted to the intensive care unit with a diagnosis of sepsis.
Collapse
Affiliation(s)
- Veysel Kaya
- Department of Radiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Mehmet Tahtabasi
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey.
| | - Yasin Akin
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ergin Karaman
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Mehmet Gezer
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Nihat Kilicaslan
- Department of Radiology, University of Health Sciences-Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| |
Collapse
|
14
|
Lebovitz S, Rozen G, Abu Ghosh Z, Korem M, Elinav H, Zayyad H, Carasso S, Planer D, Amir O, Elbaz-Greener G. The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis. J Clin Med 2023; 12:jcm12113848. [PMID: 37298043 DOI: 10.3390/jcm12113848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The association between Body Mass Index (BMI) and clinical outcomes following sepsis continues to be debated. We aimed to investigate the relationship between BMI and in-hospital clinical course and mortality in patients hospitalized with bacteremic sepsis using real-world data. METHODS A sampled cohort of patients hospitalized with bacteremic sepsis between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. In-hospital mortality and length of stay were defined as the relevant outcomes. Patients were divided into 6 BMI (kg/m2) subgroups; (1) underweight ≤ 19, (2) normal-weight 20-25, (3) over-weight 26-30, (4) obese I 31-35, (5) obese II 36-39, and (6) obese stage III ≥ 40. A multivariable logistic regression model was used to find predictors of mortality, and a linear regression model was used to find predictors of an extended length of stay (LOS). RESULTS An estimated total of 90,760 hospitalizations for bacteremic sepsis across the U.S. were analyzed. The data showed a reverse-J-shaped relationship between BMI and study population outcomes, with the underweight patients (BMI ≤ 19 kg/m2) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20-25 kg/m2) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m2). In the multivariable regression model, BMI subgroups of ≤19 kg/m2 and ≥40 kg/m2 were found to be independent predictors of mortality. CONCLUSIONS A reverse-J-shaped relationship between BMI and mortality was documented, confirming the "obesity paradox" in the real-world setting in patients hospitalized for sepsis and bacteremia.
Collapse
Affiliation(s)
- Shalom Lebovitz
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Guy Rozen
- Cardiovascular Center, Tufts Medical Center, Boston, MA 02111, USA
- Cardiac Arrhythmia Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Zahi Abu Ghosh
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Maya Korem
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Hila Elinav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Hiba Zayyad
- Infectious Diseases Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1528001, Israel
| | - Shemy Carasso
- The Jerusalem Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| |
Collapse
|
15
|
Herault A, Lévêque E, Draye-Carbonnier S, Decazes P, Zduniak A, Modzelewski R, Libraire J, Achamrah N, Ménard AL, Lenain P, Contentin N, Grall M, Leprêtre S, Lemasle E, Lanic H, Alani M, Stamatoullas-Bastard A, Tilly H, Jardin F, Tamion F, Camus V. High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock. Clin Nutr ESPEN 2023; 55:373-383. [PMID: 37202070 DOI: 10.1016/j.clnesp.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS We aimed to evaluate body composition (BC) by computed tomography (CT) in hematologic malignancy (HM) patients admitted to the intensive care unit (ICU) for sepsis or septic shock. METHODS We retrospectively assessed BC and its impact on outcome of 186 patients at the 3rd lumbar (L3) and 12th thoracic vertebral levels (T12) using CT-scan performed before ICU admission. RESULTS The median patient age was 58.0 [47; 69] years. Patients displayed adverse clinical characteristics at admission with median [q1; q3] SAPS II and SOFA scores of 52 [40; 66] and 8 [5; 12], respectively. The mortality rate in the ICU was 45.7%. Overall survival rates at 1 month after admission in the pre-existing sarcopenic vs. non pre-existing sarcopenic patients were 47.9% (95% CI [37.6; 61.0]) and 55.0% (95% CI [41.6; 72.8]), p = 0.99), respectively, at the L3 level and 48.4% (95% CI [40.4; 58.0]) vs. 66.7% (95% CI [51.1; 87.0]), p = 0.062), respectively, at the T12 level. CONCLUSIONS Sarcopenia is assessable by CT scan at both the T12 and L3 levels and is highly prevalent in HM patients admitted to the ICU for severe infections. Sarcopenia may contribute to the high mortality rate in the ICU in this population.
Collapse
Affiliation(s)
- Antoine Herault
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France; Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Alexandra Zduniak
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Romain Modzelewski
- Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Julie Libraire
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Najate Achamrah
- Department of Nutrition, Charles Nicolle University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Maximilien Grall
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Stéphane Leprêtre
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Hélène Lanic
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | | | - Hervé Tilly
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabienne Tamion
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, France
| | - Vincent Camus
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France.
| |
Collapse
|
16
|
Yang H, Wan XX, Ma H, Li Z, Weng L, Xia Y, Zhang XM. Prevalence and mortality risk of low skeletal muscle mass in critically ill patients: an updated systematic review and meta-analysis. Front Nutr 2023; 10:1117558. [PMID: 37252244 PMCID: PMC10213681 DOI: 10.3389/fnut.2023.1117558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Patients with critical illness often develop low skeletal muscle mass (LSMM) for multiple reasons. Numerous studies have explored the association between LSMM and mortality. The prevalence of LSMM and its association with mortality are unclear. This systematic review and meta-analysis was performed to examine the prevalence and mortality risk of LSMM among critically ill patients. Methods Three internet databases (Embase, PubMed, and Web of Science) were searched by two independent investigators to identify relevant studies. A random-effects model was used to pool the prevalence of LSMM and its association with mortality. The GRADE assessment tool was used to assess the overall quality of evidence. Results In total, 1,582 records were initially identified in our search, and 38 studies involving 6,891 patients were included in the final quantitative analysis. The pooled prevalence of LSMM was 51.0% [95% confidence interval (CI), 44.5-57.5%]. The subgroup analysis showed that the prevalence of LSMM in patients with and without mechanical ventilation was 53.4% (95% CI, 43.2-63.6%) and 48.9% (95% CI, 39.7-58.1%), respectively (P-value for difference = 0.44). The pooled results showed that critically ill patients with LSMM had a higher risk of mortality than those without LSMM, with a pooled odds ratio of 2.35 (95% CI, 1.91-2.89). The subgroup analysis based on the muscle mass assessment tool showed that critically ill patients with LSMM had a higher risk of mortality than those with normal skeletal muscle mass regardless of the different assessment tools used. In addition, the association between LSMM and mortality was statistically significant, independent of the different types of mortality. Conclusion Our study revealed that critically ill patients had a high prevalence of LSMM and that critically ill patients with LSMM had a higher risk of mortality than those without LSMM. However, large-scale and high-quality prospective cohort studies, especially those based on muscle ultrasound, are required to validate these findings. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022379200.
Collapse
Affiliation(s)
- Hui Yang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xi-Xi Wan
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Hui Ma
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Urology, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Li Weng
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Ying Xia
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
17
|
Darden N, Sharma S, Wu X, Mancini B, Karamchandani K, Bonavia AS. Long-Term Clinical Outcomes in Critically Ill Patients with Sepsis and Pre-existing Sarcopenia: A Retrospective Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.12.23288490. [PMID: 37131776 PMCID: PMC10153350 DOI: 10.1101/2023.04.12.23288490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose Critically ill patients with sepsis account for significant disease morbidity and healthcare costs. Sarcopenia has been proposed as an independent risk factor for poor short-term outcomes, although its effect on long-term outcomes remains unclear. Methods Retrospective cohort analysis of patients treated at a tertiary care medical center over 6 years (09/2014 - 12/2020). Critically ill patients meeting Sepsis-3 criteria were included, with sarcopenia defined by skeletal muscle index at the L3 lumbar area on abdominal Computed-Tomography scan. The prevalence of sarcopenia and its association with clinical outcomes was analyzed. Results Sarcopenia was present in 34 (23%) of 150 patients, with median skeletal muscle indices of 28.1 cm 2 /m 2 and 37.3 cm 2 /m 2 in sarcopenic females and males, respectively. In-hospital mortality was not associated with sarcopenia when adjusted for age and illness severity. One year mortality was increased in sarcopenic patients, after adjustment for illness severity (HR 1.9, p = 0.02) and age (HR 2.4, p = 0.001). However, it was not associated with increased likelihood for discharge to long-term rehabilitation or hospice care in adjusted analyses. Conclusion Sarcopenia independently predicts one year mortality but is not associated with unfavorable hospital discharge disposition in critically ill patients with sepsis.
Collapse
|