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Elgohary R, Magdy M, Sobhy E, Mansour M, Fayed A. Ultrasonographic assessment of muscle layer thickness and its relation to patient outcome in a medical intensive care unit. Clin Nutr ESPEN 2023; 55:128-135. [DOI: https:/doi.org/10.1016/j.clnesp.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Ireland M, Lo W, Villarreal M, Coleman L, Schubauer K, Strassels S, Peters Z, Woodling K, Evans D, Wisler J. Computed Tomography-Measured Psoas Muscle Density as a Predictive Factor for Hypophosphatemia Associated With Refeeding. JPEN J Parenter Enteral Nutr 2020; 45:800-809. [PMID: 32567693 DOI: 10.1002/jpen.1943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Initiation of parenteral nutrition (PN) after a period of starvation can be complicated by refeeding syndrome (RFS). RFS is associated with electrolyte abnormalities including hypomagnesemia, hyponatremia, and hypophosphatemia. Risk factors include recent weight loss, low body mass index, and electrolyte deficiencies; however, these associations are not strong. We hypothesized that a validated measure of nutrition risk, computed tomography (CT)-measured psoas muscle density, can be used to predict the development of hypophosphatemia associated with RFS. METHODS A retrospective analysis of surgical patients initiated on PN with an abdominal CT scan within the past 3 months was conducted. CT-measured psoas muscle density was assessed as a predictive variable for the development of electrolyte abnormalities. Daily electrolyte and clinical outcome measures were recorded. RESULTS One hundred nine patients were stratified based on Hounsfield unit average calculation (HUAC). The lowest 25th percentile of patients had HUAC <25. Low HUAC was associated with a significant percent decrease in phosphate levels from baseline to PN day 3 (P < .01) and significant difference in serum phosphate value on PN day 3 (P < .01). The low muscle density quartile also experienced longer days on the mechanical ventilator (P = .01) compared with patients with a higher psoas muscle density. CONCLUSION Psoas muscle density predicted the development of hypophosphatemia in patients initiated on PN. This measurement may aid in identifying patients at highest risk of experiencing RFS. A mean psoas HU <25 may prompt additional precautions, including additional phosphate replacement and slower initiation of PN.
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Affiliation(s)
- Megan Ireland
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Wilson Lo
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Michael Villarreal
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Lisa Coleman
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kathryn Schubauer
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Scott Strassels
- Center for Surgery Health Assessment, Research, and Policy (SHARP), The Ohio State University, Columbus, Ohio, USA
| | - Zoe Peters
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Karina Woodling
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - David Evans
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Jon Wisler
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
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Yoo T, Lo WD, Evans DC. Computed tomography measured psoas density predicts outcomes in trauma. Surgery 2017; 162:377-384. [PMID: 28551380 DOI: 10.1016/j.surg.2017.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/27/2017] [Accepted: 03/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Age-related loss of muscle mass and function (sarcopenia) is linked to poor outcomes after operation and trauma. Here we evaluate computed tomography measured psoas muscle density and area using quick and simple tools available to the bedside clinician. We hypothesize these measures will predict poor outcomes after blunt traumatic injury. METHODS We conducted a retrospective cohort study of patients ages ≥45 years in the Ohio State University Trauma Registry in 2008 that received a computed tomographic scan of the abdomen and/or pelvis with intravenous contrast. Psoas Index and Hounsfield unit average calculation were measured at the L3 level. In the study, 90-day mortality, complication, duration of stay ≥7 days, and dependent discharge were compared with Psoas Index and Hounsfield unit average calculation. RESULTS In the study, 151 patients met the inclusion criteria. Patients were stratified into interquartile ranges based either on Psoas Index or Hounsfield unit average calculation values. After adjustment with sex-specific cutoffs, the lowest interquartile range of Psoas Index was associated with 90-day mortality (relative risk [RR] 5.95, P < .008), but did not reach significance in other outcomes. The lowest interquartile range of Hounsfield unit average calculation was associated with 90-day mortality (RR 5.95, P < .008), duration of stay ≥ 7 days (RR 1.63, P = .048), complication risk (RR 2.30, P = .002), and dependent discharge 2.14, P = .015). CONCLUSION Psoas muscle density is a significant predictor of poor outcomes after traumatic injury. This objective, quick, and readily available measure of sarcopenia can identify patients requiring aggressive nutritional and physical therapy to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.
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Affiliation(s)
- Taehwan Yoo
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wilson D Lo
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, OH
| | - David C Evans
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, OH.
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