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Yoshinaga R, Yamada N, Hanada M, Ishimatsu Y, Kozu R. Pre-Admission Predictors of Walking Independence in Critically Ill Patients. Respir Care 2024; 69:1314-1322. [PMID: 38866416 PMCID: PMC11469001 DOI: 10.4187/respcare.11777] [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] [Indexed: 06/14/2024]
Abstract
BACKGROUND Recovery of walking independence in critically ill patients is required for safe discharge home. However, the pre-admission predictors affecting this outcome in this patient group are unknown. This study aimed to identify these predictors. METHODS We included subjects who required mechanical ventilation for at least 48 h and could walk before admission. We investigated frailty, cognitive impairment, and malnutrition risk according to the pre-admission health status. Walking independence was defined as the ability to walk for at least 45 m on level ground. The primary outcome was the association between the time to event from an ICU discharge to walking independence, and pre-admission predictors were analyzed using a Fine-Gray proportional hazards regression. RESULTS The rate of walking independence was 38.0 (100 cases/person-month; sample N = 144). In the proportional hazards regression model, adjusted for covariates, frailty (hazard ratio [HR] 0.08 [95% CI 0.01-0.67]), pre-frailty (HR 0.37 [95% CI 0.14-0.99]), cognitive impairment (HR 0.21 [95% CI 0.05-0.90]), and malnutrition risk (HR 0.20 [95% CI 0.07-0.58]) were associated with walking independence. CONCLUSIONS Pre-admission frailty or pre-frailty, cognitive impairment, and malnutrition risk can help predict walking independence in critically ill patients who require mechanical ventilation.
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Affiliation(s)
- Ryuji Yoshinaga
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and Department of Rehabilitation Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Narumi Yamada
- Department of Emergency and Critical Care Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Masatoshi Hanada
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan.
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Hardy EJ, Bass JJ, Inns TB, Piasecki M, Piasecki J, Sale C, Morris RH, Lund JN, Smith K, Wilkinson DJ, Atherton PJ, Phillips BE. Exploring the utility of ultrasound to assess disuse atrophy in different muscles of the lower leg. J Cachexia Sarcopenia Muscle 2024. [PMID: 39183641 DOI: 10.1002/jcsm.13583] [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: 01/14/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Skeletal muscle is a highly plastic tissue crucial for many functions associated with whole-body health across the life course. Magnetic resonance imaging (MRI) is the current gold standard for measuring skeletal muscle size. However, MRI is expensive, and access to facilities is often limited. B-mode ultrasonography (U/S) has been proposed as a potential alternative to MRI for the assessment of muscle size. However, to date, no work has explored the utility of U/S to assess disuse muscle atrophy (DMA) across muscles with different atrophy susceptibility profiles, an omission which may limit the clinical application of previous work. METHODS To address this significant knowledge gap, 10 young men (22 ± years, 24.1 ± 2.3 kg/m2) underwent 15-day unilateral leg immobilization using a knee-brace and air boot. Cross-sectional area (CSA) and muscle thickness (MT) of the tibialis anterior (TA) and medial gastrocnemius (MG) were assessed via U/S before and after immobilization, with CSA and muscle volume assessed via MRI. RESULTS With both muscles combined, there were good correlations between each U/S and MRI measure, both before (e.g., CSAMRI vs. MTU/S and CSAU/S: r = 0.88 and 0.94, respectively, both P < 0.0001) and after (e.g., VOLMRI vs. MTU/S and CSAU/S: r = 0.90 and 0.96, respectively, both P < 0.0001) immobilization. The relationship between the methods was notably stronger for MG than TA at each time-point (e.g., CSAMRI vs. MTU/S: MG, r = 0.70, P = 0.0006; TA, r = 0.37, P = 0.10). There was no relationship between the degree of DMA determined by the two methods in either muscle (e.g., TA pre- vs. post-immobilization, VOLMRI: 136 ± 6 vs. 133 ± 5, P = 0.08; CSAU/S: 6.05 ± 0.3 vs. 5.92 ± 0.4, P = 0.70; relationship between methods: r = 0.12, P = 0.75). CONCLUSIONS Both MTU/S and CSAU/S provide comparable static measures of lower leg muscle size compared with MRI, albeit with weaker agreement in TA compared to MG. Although both MTU/S and CSAU/S can discern differences in DMA susceptibility between muscles, neither can reliably assess degree of DMA. Based on the growing recognition of heterogeneous atrophy profiles between muscles, and the topical importance of less commonly studied muscles (i.e., TA for falls prevention in older adults), future research should aim to optimize accessible methods to determine muscle losses across the body.
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Affiliation(s)
- Edward J Hardy
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Joseph J Bass
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Thomas B Inns
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Mathew Piasecki
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Jessica Piasecki
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Craig Sale
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
- Institue of Sport, Manchester Metropolitan University, Manchester, UK
| | - Robert H Morris
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Jonathan N Lund
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Ken Smith
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Daniel J Wilkinson
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Philip J Atherton
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
| | - Bethan E Phillips
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, University of Nottingham, School of Medicine, Derby, UK
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Kangalgil M, Ulusoy H, Ayaz S. Acute Skeletal Muscle Wasting is Associated with Prolonged Hospital Stay in Critical Illness with Brain Injury. Neurocrit Care 2024:10.1007/s12028-024-02017-y. [PMID: 38918337 DOI: 10.1007/s12028-024-02017-y] [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: 12/27/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Acute muscle wasting is common in critically ill patients, and this can lead to unfavorable clinical outcomes. The aim of this study was to identify factors associated with muscle wasting and to investigate the association between skeletal muscle wasting and prolonged hospital stay in critically ill patients with acute brain injury. METHODS This single-center prospective observational study was conducted in critically ill patients with acute brain injury who stayed in the intensive care unit for at least 1 week. The rectus femoris cross-sectional area was measured via ultrasound at baseline and a week after the first assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted prolonged hospital stay. RESULTS A total of 86 patients were included in the study. Their mean age was 49.4 ± 16.9 years, 57% were male, and 46.5% had an admission diagnosis of subarachnoid hemorrhage. The percentage change in the rectus femoris cross-sectional area was 15.8% (95% confidence interval [CI] - 19.8% to - 12.0%; p < 0.001), and 57% of all patients had acute muscle wasting. According to the univariate analysis, there was a significant association between prolonged hospital stay and acute muscle wasting (odds ratio [OR] 3.677; 95% CI 1.487-9.043; p = 0.005), mechanical ventilation status (OR 3.600; 95% CI 1.455-8.904; p = 0.006), and Glasgow Coma Scale score (OR 0.888; 95% CI 0.808-0.976; p = 0.014) at intensive care unit admission. The multivariate analysis demonstrated that acute muscle wasting (OR 3.449; 95% CI 1.344-8.853; p = 0.010) was an independent risk factor for prolonged hospital stay. CONCLUSIONS There was considerable muscle wasting in critically ill patients with brain injuries over a 1-week period. Acute muscle wasting was associated with prolonged hospital stay in critically ill patients with acute brain injury.
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Affiliation(s)
- Melda Kangalgil
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Hülya Ulusoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sekine Ayaz
- Department of Anesthesiology and Reanimation, Pasinler Ibrahim Hakkı State Hospital, Erzurum, Turkey
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Kurt C, Yumusakhuylu Y, Erhan B. A Case Report of Probable Secondary Sarcopenia After Intensive Care Hospitalization. J Frailty Sarcopenia Falls 2024; 9:157-160. [PMID: 38835624 PMCID: PMC11145097 DOI: 10.22540/jfsf-09-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 06/06/2024] Open
Abstract
Malnutrition, inflammation, comorbid diseases, and inactivity are known causes of sarcopenia. It results in clinical consequences like fractures, falls, low quality of life, cognitive dysfunction, and mortality. Especially in the treatment of patients with prolonged immobilization syndrome, management should not only focus on functional limitations but patients should also be evaluated and followed up for sarcopenia. In this case report, we present the management of probable secondary sarcopenia in the intensive care unit as a result of urosepsis and discuss it in the light of the literature.
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Affiliation(s)
- Cihat Kurt
- Istanbul Medeniyet University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Yasemin Yumusakhuylu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Belgin Erhan
- Istanbul Medeniyet University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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Yau DKW, Griffith JF, Underwood MJ, Joynt GM, Lee A. Preoperative rectus femoris muscle ultrasound, its relationship with frailty scores, and the ability to predict recovery after cardiac surgery: a prospective cohort study. Perioper Med (Lond) 2024; 13:45. [PMID: 38783315 PMCID: PMC11112902 DOI: 10.1186/s13741-024-00401-y] [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: 04/25/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty. METHODS This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST5m). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH30). RESULTS By CFS and GST5m criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH30 (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone. CONCLUSIONS Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery. TRIAL REGISTRATION The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
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Affiliation(s)
- Derek King Wai Yau
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Malcolm John Underwood
- Cardiovascular Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR
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Hafızoğlu M, Yıldırım HK, Okyar Baş A, Karaduman D, Şahiner Z, Doğu BB, Halil MG, Cankurtaran M, Balcı C. Role of muscle ultrasound in frailty assessment in older adults with type 2 diabetes mellitus. BMC Geriatr 2024; 24:397. [PMID: 38704521 PMCID: PMC11069196 DOI: 10.1186/s12877-024-05008-y] [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: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that is characterized by increased vulnerability to intrinsic and extrinsic stressors due to decreased biologic reserves. Muscle ultrasound (US) is a valid and reliable method for assessing muscle quantity in older adults. The study aims to examine the relationship between frailty definitions and US-derived muscle parameters. METHODS We conducted a cross-sectional study with type 2 diabetes mellitus outpatients in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment. For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed. Muscle US measurements included Gastrocnemius Medialis (GM) muscle thickness, GM fascicle length, GM pennation angle, Rectus Femoris (RF) muscle thickness, Rectus Femoris cross-sectional area (RFCSA), Rectus Abdominis (RA) muscle thickness, External Oblique (EO) muscle thickness, Internal Oblique (IO) muscle thickness, and Transverse Abdominis (TA) muscle thickness. RESULTS In all, 373 participants were included in the study. The median age of participants was 72.7 ± 5.9 years, and 64.6% of them were female. According to the FFP, 18.2% of the participants were living with frailty, 56% of them were pre-frail; 57.4% of them were living with frailty according to the CFS; 25.2% of them were living with frailty, and 20.6% of them were pre-frail according to the EFS. The FFP, CFS, and EFS scores were related to muscle thickness of GM, RF, and RA, fascicle length of GM, and pennation angle of GM and RFCSA. Particularly, GM pennation angle, RF muscle thickness, and RFCSA were associated with an increased risk of frailty. Besides muscle thickness of GM, RF, and RA, fascicle length of GM, pennation angle of GM, and RFCSA were significant for predicting the presence of frailty. CONCLUSIONS US-derived regional muscle measurements are associated with frailty definitions (in both physical, cumulative deficit, and multidimensional models) in a diabetic geriatric population.
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Affiliation(s)
- Merve Hafızoğlu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Hatice Kübra Yıldırım
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Karaduman
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Şahiner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Wang Z, Han S, Xiao Y, Zhang Y, Ge Y, Liu X, Gao J. Genetically supported causality between gut microbiota and frailty: a two-sample Mendelian randomization study. Front Microbiol 2024; 15:1324209. [PMID: 38741737 PMCID: PMC11089315 DOI: 10.3389/fmicb.2024.1324209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
Background A mounting body of evidence suggests a strong connection between gut microbiota and the risk of frailty. However, the question of causality remains unanswered. In this study, we employed a Mendelian randomization (MR) approach to assess potential causal relationships between gut microbiota and the risk of frailty. Materials and methods Summary statistics for the gut microbiome were obtained from a genome wide association study (GWAS) meta-analysis of the MiBioGen consortium (N = 18,340). Summary statistics for frailty were obtained from a GWAS meta-analysis, including the UK Biobank and TwinGene (N = 175,226). Our primary analysis utilized the inverse variance weighted (IVW) method. To enhance the robustness of our results, we also applied weighted median methods, MR Egger regression, and MR pleiotropy residual sum and outlier test. Finally, we conducted reverse MR analysis to investigate the potential for reverse causality. Results IVW method identified 7 bacterial taxa nominally associated with the risk of FI. Class Bacteroidia (p = 0.033) and genus Eubacterium ruminantium group (p = 0.028) were protective against FI. In addition, class Betaproteobacteria (p = 0.042), genus Allisonella (p = 0.012), genus Bifidobacterium (p = 0.013), genus Clostridium innocuum group (p = 0.036) and genus Eubacterium coprostanoligenes group (p = 0.003) were associated with a higher risk of FI. No pleiotropy or heterogeneity were found. Conclusion The MR analysis indicates a causal relationship between specific gut microbiota and FI, offering new insights into the mechanisms underlying FI mediated by gut microbiota.
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Affiliation(s)
- Zi Wang
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Shuai Han
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yinggang Xiao
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yang Zhang
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yali Ge
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Xin Liu
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Ju Gao
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
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Takenoshita M, Weir McCall JR, Barker AP, Suresh S, Celik H, Vuylsteke A. Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support. Clin Radiol 2024; 79:272-278. [PMID: 38278741 DOI: 10.1016/j.crad.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
AIM To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. MATERIALS AND METHODS A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival. RESULTS The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047). CONCLUSIONS Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.
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Affiliation(s)
- M Takenoshita
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - J R Weir McCall
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK.
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - S Suresh
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - H Celik
- University of Massachusetts Chan Medical School, Massachusetts, USA
| | - A Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Ben-Menachem E, Ashes C, Lepar G, Deacon J, Glavan N, Molan V, Watson A. Smaller rectus femoris size measured by ultrasound is associated with poorer outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2024; 167:1115-1122.e5. [PMID: 35995604 DOI: 10.1016/j.jtcvs.2022.07.005] [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: 12/06/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to evaluate the association of low rectus femoris cross-sectional area (RFCSA) with hospital length of stay and poorer outcomes in patients undergoing cardiac surgery. METHODS A single right-leg RFCSA was measured with ultrasound preoperatively and baseline characteristics, clinical data, and outcomes recorded. Patients were categorized as low rectus femoris muscle size (lowRF) or normal rectus femoris muscle size (normalRF), if they were in the lowest quartile or not, respectively. All analyses were performed on both body surface area (BSA)- and sex-adjusted RFCSA. RESULTS One hundred eight-four patients had a RFCSA measured with a mean of 5.01 cm2 (1.41 cm2), and range of 0.71 to 8.77 cm2. When analyzing the BSA-adjusted RFCSA, we found the lowRF group had a longer hospital stay, 11.0 days [7.0-16.3] versus 8.0 days [6.0-10.0] for the normalRF group (P < .001), and a greater proportion of extended hospital stay (≥18.5 days) of 19.6% compared with 6.2% (P = .010). When the RFCSA was adjusted for sex, the lowRF group had a greater length of hospital stay, 9.0 days [7.0-14.5] versus 8.0 days [6.0-11.0] (P = .049). In both the BSA- and sex-adjusted RFCSA, the lowRF group suffered greater morbidity and were more likely discharged to a destination other than home. In multivariate analyses adjusting for European System for Cardiac Operative Risk Evaluation II, BSA-adjusted lowRF but not sex-adjusted lowRF was independently associated with log-transformed hospital length of stay. LowRF was not independently associated with increased major morbidity and death for both BSA and sex-adjusted RFCSA. CONCLUSIONS Low RFCSA has a significant association with increased hospital length of stay, morbidity, and nonhome discharge in patients undergoing cardiac procedures. TRIAL REGISTRY NUMBER ACTRN12620000678998.
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Affiliation(s)
- Erez Ben-Menachem
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; Notre Dame School of Medicine, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.
| | - Catherine Ashes
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Gila Lepar
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - James Deacon
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Nicole Glavan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Veronique Molan
- Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia
| | - Alasdair Watson
- St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia; Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
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Ferguson CE, Lambell KJ, Ridley EJ, Goh GS, Hodgson CL, Holland AE, Harrold M, Chan T, Tipping CJ. Muscularity of older trauma patients at intensive care unit admission, association with functional outcomes, and relationship with frailty: A retrospective observational study. Aust Crit Care 2024; 37:205-211. [PMID: 37532620 DOI: 10.1016/j.aucc.2023.06.008] [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: 02/28/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Older individuals are at an increased risk of delayed recovery following a traumatic injury. Measurement of muscularity and frailty at hospital admission may aid with prognostication and risk stratification. OBJECTIVE This study aimed to describe muscularity at intensive care unit (ICU) admission in patients admitted following trauma and assess the relationship between muscularity and clinical, long-term functional outcomes and frailty at ICU admission. METHODS This retrospective study utilised data from a prospective observational study investigating frailty in patients aged ≥50 years, admitted to the ICU following trauma. Patients were eligible if they had a Computed Tomography (CT) scan including the third lumbar vertebra at ICU admission. Specialist software was used to quantify CT-derived skeletal muscle cross-sectional area. Muscularity status was classified as normal or low using published sex-specific cut-points. Demographic data, frailty, clinical, and long-term functional outcomes (Glasgow Outcome Scale-Extended and EQ-5DL-5L Visual analogue scale and utility score) were extracted from the original study. RESULTS One hundred patients were screened; 71 patients had a CT scan on admission with 66 scans suitable for muscle assessment. Patients with low muscularity (n = 25, 38%) were older and had a higher Acute Physiology and Chronic Health Evaluation II score and lower body mass index than patients with normal muscularity. Low muscularity was associated with frailty at admission (32% vs 5%, p = 0.005) but not with long term outcomes at 6 or 12 months. As a continuous variable, lower muscle cross-sectional area was associated with a poorer outcome on the Glasgow Outcome Scale-Extended at 6 months (mean [standard deviation]: 150 [43] and 180 [44], respectively; p = 0.014), no association was observed after adjustment for age p = 0.43). CONCLUSION In a population of older adults hospitalised following trauma, low muscularity at ICU admission was prevalent. Low muscularity was associated with frailty but not long-term functional outcomes. Larger studies are warranted to better understand the relationship between muscularity and long-term functional outcomes.
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Affiliation(s)
- Clare E Ferguson
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - Kate J Lambell
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Emma J Ridley
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - Gerard S Goh
- Department of Radiology, The Alfred, Melbourne, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia.
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; The George Institute for Global Health; Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Anne E Holland
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia; Respiratory Research @ Alfred, Department of Immunology & Pathology, The Central Clinical School, Monash University, Australia.
| | - Meg Harrold
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Terry Chan
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Claire J Tipping
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
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11
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Yi J, Hahn S, Oh K, Lee YH. Sarcopenia prediction using shear-wave elastography, grayscale ultrasonography, and clinical information with machine learning fusion techniques: feature-level fusion vs. score-level fusion. Sci Rep 2024; 14:2769. [PMID: 38307965 PMCID: PMC10837421 DOI: 10.1038/s41598-024-52614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024] Open
Abstract
This study aimed to develop and evaluate a sarcopenia prediction model by fusing numerical features from shear-wave elastography (SWE) and gray-scale ultrasonography (GSU) examinations, using the rectus femoris muscle (RF) and categorical/numerical features related to clinical information. Both cohorts (development, 70 healthy subjects; evaluation, 81 patients) underwent ultrasonography (SWE and GSU) and computed tomography. Sarcopenia was determined using skeletal muscle index calculated from the computed tomography. Clinical and ultrasonography measurements were used to predict sarcopenia based on a linear regression model with the least absolute shrinkage and selection operator (LASSO) regularization. Furthermore, clinical and ultrasonography features were combined at the feature and score levels to improve sarcopenia prediction performance. The accuracies of LASSO were 70.57 ± 5.00-81.54 ± 4.83 (clinical) and 69.00 ± 4.52-69.73 ± 5.47 (ultrasonography). Feature-level fusion of clinical and ultrasonography (accuracy, 70.29 ± 6.63 and 83.55 ± 4.32) showed similar performance with clinical features. Score-level fusion by AdaBoost showed the best performance (accuracy, 73.43 ± 6.57-83.17 ± 5.51) in the development and evaluation cohorts, respectively. This study might suggest the potential of machine learning fusion techniques to enhance the accuracy of sarcopenia prediction models and improve clinical decision-making in patients with sarcopenia.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kangrok Oh
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science (CCIDS), Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
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12
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Peres LM, Luis-Silva F, Menegueti MG, Lovato WJ, Espirito Santo DAD, Donadel MD, Sato L, Malek-Zadeh CH, Basile-Filho A, Martins-Filho OA, Auxiliadora-Martins M. Comparison between ultrasonography and computed tomography for measuring skeletal muscle mass in critically ill patients with different body mass index. Clin Nutr ESPEN 2024; 59:214-224. [PMID: 38220379 DOI: 10.1016/j.clnesp.2023.12.012] [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: 07/04/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIM Among critical patients, there is an early onset of changes in both the quantity and quality of muscle mass. It is essential to find tools that promptly identify this muscle mass loss. The aim of this study was to compare the ultrasonography of the quadriceps femoris to the gold standard, thigh computed tomography (CT) for assessing the musculature of critically ill patients with different body mass index who have suffered traumatic brain injury. METHODS This is a prospective validation study in an Intensive Care Unit (ICU) specialized in trauma care, located at a tertiary teaching hospital. Our study involved a convenience sample of patients. Sequential ultrasound and CT scans were performed at three distinct time intervals: upon admission, between 24 and 96 h' post-admission, and finally, between 96 and 168 h' post-admission. For all ultrasound measurements, we conducted simultaneous quadriceps CT measurements. The correlation between measurements obtained by ultrasound and computed tomography at three different times and in three BMI ranges was analyzed, in individuals with normal weight, overweight and obese. RESULTS Results: We analyzed 252 images in 49 patients in time 1, 40 patients in time 2, and 37 in time 3 to compare the thickness quadriceps muscle using US and CT. Of these, 18 patients had a BMI ≤ 24.9 kg/m2 (normal weight), 18 patients from 25 to 29.9 kg/m2 (overweight), and 8 patients had a BMI ≥ 30 kg/m2 (obese). The mean age was 37 years, the majority (94%) were male and the main comorbidities were: hypertension 12%, diabetes 4% and 14% smoking. The results revealed minor discrepancies between measurements obtained through the two methods, these changes were not influenced by the body mass index, with these variations being practically insignificant in the context of clinical application. Thus, the correlation and concordance between the values obtained found a strong positive correlation with good limits of agreement. The Spearman's correlation coefficients obtained were r = 0.89, 0.91 and 0.88, p < 0.01 at T1, T2 and T3 respectively for normal weight, r = 0.91, 0.80 and 0.81, p < 0.01 at T1, T2 and T3 respectively for overweight and r = 0.89, 0.94 and 0.84, p < 0.01 at T1, T2 and T3 respectively for obesity. In addition to a positive correlation, we observed a high agreement between the methods. The Bland & Altman analysis at time 1 showed, respectively, the bias of 1.46, 2.03 and 0.76. At time 2, the bias was 0.42, 3.11 and 2.12. At time 3, the bias was 2.26, 3.38 and 2.11 mm. CONCLUSION Our findings suggest that measure femoral quadriceps muscle thickness ultrasound-based exhibits a comparable performance to thigh CT. This conclusion stems from the excellent correlation and good agreement observed between ultrasound and CT, which is considered the gold standard for muscle assessment in critically ill patients. TRIAL REGISTRATION This clinical trial is registered at REBEC https://ensaiosclinicos.gov.br/ identifier: RBR-2bzspnz. The protocol was approved, on July 30, 2019, by the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto - Trial Registration Number: 3,475,851.
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Affiliation(s)
- Leandro Moreira Peres
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fabio Luis-Silva
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Wilson José Lovato
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Douglas Alexandre do Espirito Santo
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Mariana Derminio Donadel
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Lucas Sato
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Carolina Hunger Malek-Zadeh
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Auxiliadora-Martins
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
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13
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Martis WR. The potential use of perioperative rectus femoris ultrasonography in guiding prehabilitation strategies. J Clin Anesth 2024; 92:111302. [PMID: 37862865 DOI: 10.1016/j.jclinane.2023.111302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Affiliation(s)
- W R Martis
- Anaesthesia Fellow, Department of Anaesthetics, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
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14
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Xin C, Ma M, Wang Q, Li T, Sun Q, Jiang M, Du J, Li Z, Ma J. Correlation of ultrasound measurement of limb muscle thickness and echo intensity with frailty assessment in elderly patients undergoing malignancies surgery. Heliyon 2024; 10:e24017. [PMID: 38230231 PMCID: PMC10789593 DOI: 10.1016/j.heliyon.2024.e24017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
Introduction It remains controversial which frailty score correlates with adverse outcomes. Instead of these subjective and time consuming scores, we studied whether ultrasound guided lower extremity thickness measurements more closely are associated with adverse outcomes. Method Patients undergoing gastrointestinal malignancy surgery were included as study subjects. Frailty was identified using the FRAIL scale assessment. Ultrasound measured the muscle thickness and echo intensity of the patient's upper and lower limbs. ANOVA was used to analyze the relationship between muscle data and frailty assessment. Significant indicators from the one-way analysis were included in the multivariate logistic regression equation. Results A total of 160 study subjects were included, 52 in the normal group, 78 in the prefrailty group, and 30 in the frailty group. The ANOVA showed that there were significant differences in age, hemoglobin, albumin, history of hypertension, history of coronary artery disease, the history of cerebrovascular disease, rate of postoperative complications, rate of transferring to intensive care unit, time out of bed, length of hospitalization, thickness and echo intensity of quadriceps femoris the vastus lateralis and the tibialis anterior, echo intensity of the medial gastrocnemius among the three groups (P < 0.05). Pearson's correlation analysis showed FRAIL score was correlated with muscle thickness and echo intensity of the lower limbs. Multifactor logistic regression analysis showed that the prefrailty group was positively correlated with age(β = 0.146, P = 0.004), echo intensity of the medial gastrocnemius (β = 0.055, P = 0.031), and rate of postoperative complications(β = 1.439, P = 0.021), also negatively correlated with muscle thickness of the tibialis anterior(β = -2.124, P = 0.007). The frailty group was positively correlated with age(β = 0.22, P = 0.005), tibialis anterior echo intensity (β = 0.082, P = 0.015), medial gastrocnemius echo intensity (β = 0.089, P = 0.026), cerebrovascular disease history (β = 2.311, P = 0.04), and postoperative complication rate (β = 2.684, P = 0.003). It was negatively correlated with albumin (β = -0.26, P = 0.017), quadriceps muscle thickness (β = -2.257, P = 0.017), and tibialis anterior muscle thickness (β = -5.408, P = 0.001). Conclusion Ultrasound measurement of lower (not upper) extremity muscle thickness and echo intensity was significantly associated with discriminating severity of frailty and postoperative outcomes than frailty scores in elderly patients.
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Affiliation(s)
- Chengjian Xin
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Mengzhuo Ma
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Qian Wang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Tao Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Qiaoxia Sun
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Meiru Jiang
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Juan Du
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Zhi Li
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
| | - Jiahai Ma
- Department of Anesthesia, Yuhuangding Hospital, Yaitai, China
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15
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Lima J, Foletto E, Cardoso RCB, Garbelotto C, Frenzel AP, Carneiro JU, Carpes LS, Barbosa-Silva TG, Gonzalez MC, Silva FM. Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings. Clin Nutr 2024; 43:95-110. [PMID: 38016244 DOI: 10.1016/j.clnu.2023.11.003] [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: 07/01/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
AIMS This scoping review aimed to identify, explore, and map the objectives, methodological aspects, and results of studies that used ultrasound (US) to assess skeletal muscle (SM) in critically ill patients. METHODS A scoping review was conducted according to the Joanna Briggs Institute's methodology. All studies that evaluated SM parameters from the US in patients admitted to the intensive care unit (ICU) were considered eligible. We categorized muscle thickness and cross-sectional area as parameters for assessing SM quantity, while echogenicity, fascicle length, and pennation angle analysis were used to evaluate muscle "quality" (composition/architecture). A literature search was conducted using four databases for articles published until December 2022. Independent reviewers selected the studies and extracted data. Descriptive statistics were calculated to present the results. RESULTS A total of 107 studies were included, the majority of which were prospective cohort studies (59.8 %) conducted in general ICUs (49.5 %). The most frequent objective of the studies was to evaluate SM quantity depletion during the ICU stay (25.2 %), followed by determining whether a specific intervention would modify SM (21.5 %). Most studies performed serial SM evaluations (76.1 %). The rectus femoris muscle thickness was evaluated in most studies (67.9 %), followed by the rectus femoris cross-sectional area (54.3 %) and the vastus intermedius muscle thickness (40.2 %). The studies demonstrated the feasibility and reproducibility of US for SM evaluation, especially related to quantitative parameters. Most studies (70.3 %) reported significant SM quantity depletion during hospitalization. However, the accuracy of the US in measuring SM varied across the studies. CONCLUSIONS The lack of detailed description and standardization in the protocols adopted by the studies included in this scoping review precludes the translation of the evidence related to US for SM assessment into clinical practice.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Estéfani Foletto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Rafaella C B Cardoso
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Charlles Garbelotto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas Brazil
| | - Juliana U Carneiro
- Multiprofessional Residency Program: Intensive Care. Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Larissa S Carpes
- Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre Brazil
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas Brazil
| | | | - Flávia M Silva
- Nutrition Department and Nutrition Science Graduate Program. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre Brazil.
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16
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Kim H, Kwon S, Kim Y, Bae J, Yoo S, Lim YJ, Kim JT. Preoperative frailty assessment with ultrasound in elderly patients scheduled for total knee arthroplasty. Minerva Anestesiol 2024; 90:59-67. [PMID: 38415511 DOI: 10.23736/s0375-9393.23.17713-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty. METHODS Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded. RESULTS We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values. CONCLUSIONS Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.
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Affiliation(s)
- Hansol Kim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Seokmin Kwon
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon-si, South Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, National University College of Medicine of Seoul, Seoul, South Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, National University Hospital of Seoul, Seoul, South Korea -
- Department of Anesthesiology and Pain Medicine, National University College of Medicine of Seoul, Seoul, South Korea
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
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17
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Marín-Baselga R, Sanz-Ortega C, Platero-Dueñas L, Sorriguieta-Torre R, Palma-Milla S, Tung-Chen Y. Nutritional assessment by ultrasound of the rectus femoris and preperitoneal adipose tissue as predictors of hospitalized patient complications. Rev Clin Esp 2023; 223:640-646. [PMID: 37865334 DOI: 10.1016/j.rceng.2023.10.002] [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: 05/29/2023] [Accepted: 09/11/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Malnutrition and sarcopenia are associated with increased risk of adverse events and worse outcome in hospitalised patients. Ultrasonography is a useful tool in the assessment of body composition. PATIENTS AND METHODS Twenty-three patients admitted to a hospital ward were recruited. Ultrasonographic variables of muscle tissue and adipose tissue were collected, as well as their variation during admission. These were correlated with anthropometric, clinical and analytical data. RESULTS We observed a correlation of ultrasound measurements with length of hospitalisation (maximum preperitoneal fat -0.585, rectus femoris thickness - RF -0.539, RF area -0.540), frailty (RF -0.599) and dependency (RF 0.628). RF contractile capacity correlated with reported weekly exercise (0.642). CONCLUSION RF and preperitoneal fat thickness correlate with the number of days of admission and functional capacity, emerging as prognostic variables.
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Affiliation(s)
- R Marín-Baselga
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | - C Sanz-Ortega
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - L Platero-Dueñas
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | | | - S Palma-Milla
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición Hospital Universitario La Paz, Madrid, Spain
| | - Y Tung-Chen
- Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain.
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18
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Mazwi N, Lissak I, Wongtangman K, Platzbecker K, Albrecht L, Teja B, Xu X, Morteo NM, Sparling T, Latronico N, Barbieri S, Blobner M, Schaller SJ, Eikermann M. Effects of mobility dose on discharge disposition in critically ill stroke patients. PM R 2023; 15:1547-1556. [PMID: 37448373 DOI: 10.1002/pmrj.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/14/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remain unclear. OBJECTIVE To assess the effect of mobilization dose in the ICU on adverse discharge disposition in patients after stroke. DESIGN This is an international, prospective, observational cohort study of critically ill stroke patients (November 2017-September 2019). Duration and intensity of mobilization was quantified daily by the mobilization quantification score (MQS). SETTING Patients requiring ICU-level care were enrolled within 48 hours of admission at four separate academic medical centers (two in Europe, two in the United States). PARTICIPANTS Participants included individuals (>18 years old) admitted to an ICU within 48 hours of ischemic or hemorrhagic stroke onset who were functionally independent at baseline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome was adverse discharge disposition. RESULTS Of the patients screened, 163 were eligible for inclusion in the study. One patient was subsequently excluded due to insufficient data collection (n = 162). The dose of mobilization varied greatly between centers and patients, which could not be explained by patients' comorbidities or disease severity. High dose of mobilization (mean MQS > 7.3) was associated with a lower likelihood of adverse discharge (adjusted odds ratio, [aOR]: 0.14; 95% confidence interval [CI]: 0.06-0.31; p < .01). CONCLUSION The increased use of mobilization acutely in the ICU setting may improve patient outcomes.
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Affiliation(s)
- Nicole Mazwi
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - India Lissak
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karuna Wongtangman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Lea Albrecht
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Anesthesiology and Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole M Morteo
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Silvia Barbieri
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- University of Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ulm, Germany
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care, Berlin, Germany
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Montefiore Medical Center, Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
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Elkalawy H, Sekhar P, Abosena W. Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review. Acute Crit Care 2023; 38:409-424. [PMID: 38052508 DOI: 10.4266/acc.2023.00703] [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: 05/14/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.
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Affiliation(s)
- Hanan Elkalawy
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Pavan Sekhar
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Wael Abosena
- Department of Surgery, Faculty of Medicine, Tanta University, Gharbeya, Egypt
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20
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Liu L, Liu S, Hao M, Hu S, Yu T, Yang Y, Liu Z. Sarcopenia as an important determinant for adverse outcomes in patients with pyogenic liver abscess. PeerJ 2023; 11:e16055. [PMID: 37810784 PMCID: PMC10559880 DOI: 10.7717/peerj.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Background Low muscle mass/sarcopenia has been associated with poor prognosis in many diseases, but its clinical significance in pyogenic liver abscess (PLA) remains unclear. The purpose of this study is to investigate the relationship between muscle mass and prognosis of patients with PLA. Methods A total of 154 adult patients with PLA hospitalized at Tongji Hospital (Wuhan, Hubei, China) between October 2011 and June 2021 were included in this retrospective analysis. Muscle-fat related indicators were measured by computed tomography (CT) images at the third lumbar vertebra (L3) level. The data of patients between the sarcopenia group and non-sarcopenia group were compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results The skeletal muscle index (SMI) was independently associated with adverse outcomes (95% CI [0.649-0.954], P = 0.015) of PLA in multivariate logistic regression analysis. This conclusion held true in sex-specific subgroup analysis. ROC analysis indicated that SMI may predict adverse outcomes in both male (area under the ROC curve [AUC], 0.718; cut-off, 52.59; P < 0.001) and female (AUC, 0.714; cut-off, 38.39; P = 0.017) patient populations. Conclusions Sarcopenia serves as an independent risk factor for poor prognosis in PLA and patients with sarcopenia may be more prone to adverse outcomes.
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Affiliation(s)
- Li Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Shaohua Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Meng Hao
- Department of Gastroenterology, Zigui County People’s Hospital, Yichang, China
| | - Song Hu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
| | - Yunkai Yang
- Eight-year Program of Clinical Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhelong Liu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China
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21
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Becchetti C, Berzigotti A. Ultrasonography as a diagnostic tool for sarcopenia in patients with cirrhosis: Examining the pros and cons. Eur J Intern Med 2023; 116:27-33. [PMID: 37385916 DOI: 10.1016/j.ejim.2023.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Sarcopenia has emerged as a significant prognostic factor in liver disease, posing a significant risk to patients in terms of morbidity and mortality. However, the evaluation of skeletal muscle mass and quality remains challenging, as cross-sectional imaging is not a suitable screening tool. In order to better include this crucial variable in the routine risk stratification of patients with chronic liver disease, there is an urgent need for simple and reliable non-invasive diagnostic tools for sarcopenia. Therefore, the use of ultrasound techniques has garnered attention as a promising alternative for detecting sarcopenia and muscle abnormalities. This narrative review aims to provide an overview of the current literature on the use of ultrasound as a diagnostic tool for sarcopenia, with particular focus on patients with cirrhosis, emphasizing its potential limitations and future prospects.
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Affiliation(s)
- Chiara Becchetti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Hepatology and Gastroenterology Division, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Hospital, Milan, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland.
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22
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Mirón-Mombiela R, Ruiz-España S, Moratal D, Borrás C. Assessment and risk prediction of frailty using texture-based muscle ultrasound image analysis and machine learning techniques. Mech Ageing Dev 2023; 215:111860. [PMID: 37666473 DOI: 10.1016/j.mad.2023.111860] [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: 04/25/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
The purpose of this study was to evaluate texture-based muscle ultrasound image analysis for the assessment and risk prediction of frailty phenotype. This retrospective study of prospectively acquired data included 101 participants who underwent ultrasound scanning of the anterior thigh. Participants were subdivided according to frailty phenotype and were followed up for two years. Primary and secondary outcome measures were death and comorbidity, respectively. Forty-three texture features were computed from the rectus femoris and the vastus intermedius muscles using statistical methods. Model performance was evaluated by computing the area under the receiver operating characteristic curve (AUC) while outcome prediction was evaluated using regression analysis. Models developed achieved a moderate to good AUC (0.67 ≤ AUC ≤ 0.79) for categorizing frailty. The stepwise multiple logistic regression analysis demonstrated that they correctly classified 70-87% of the cases. The models were associated with increased comorbidity (0.01 ≤ p ≤ 0.18) and were predictive of death for pre-frail and frail participants (0.001 ≤ p ≤ 0.016). In conclusion, texture analysis can be useful to identify frailty and assess risk prediction (i.e. mortality) using texture features extracted from muscle ultrasound images in combination with a machine learning approach.
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Affiliation(s)
- Rebeca Mirón-Mombiela
- Department of Physiology, Universitat de València/INCLIVA, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; Hospital General Universitario de Valencia (HGUV), Valencia, Spain; Herlev og Gentofte Hospital, Herlev, Denmark.
| | - Silvia Ruiz-España
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain.
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain.
| | - Consuelo Borrás
- Department of Physiology, Universitat de València/INCLIVA, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; INCLIVA Health Research Institute, Av/ de Menéndez y Pelayo, 4, 46010 Valencia, Spain; Center for Biomedical Network Research on Frailty and Healthy Aging (CIBERFES), CIBER-ISCIII, Valencia, Spain.
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23
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Ackermans LLGC, Bels JLM, Seethaler B, van Dinter M, Schweinlin A, van de Poll MCG, Bischoff SC, Poeze M, Blokhuis TJ, Ten Bosch JA. Serum metabolomics analysis for quantification of muscle loss in critically ill patients: An explorative study. Clin Nutr ESPEN 2023; 57:617-623. [PMID: 37739714 DOI: 10.1016/j.clnesp.2023.08.012] [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: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND During Intensive Care Unit (ICU) admission, patients demonstrate up to 15% muscle loss per week, contributing to neuromuscular weakness, complicating recovery and delaying return to daily life. Biomarkers for muscle loss could aid in early detection of patients at risk and help guide resources to mitigate muscle loss, e.g. physical therapy and protein supplementation. AIMS To explore serum biomarkers for muscle mass and muscle loss in ICU patients using a metabolomics approach. METHODS Mechanically ventilated patients with an unplanned ICU admission between June and December 2021 were prospectively studied. The cross-sectional area of the rectus femoris muscle was assessed using ultrasound (RFcsa) and 188 serum metabolites were assessed using the Biocrates™ AbsoluteIDQ p180 kit for targeted metabolomics. Patients were eligible for analysis when a serum sample drawn within 5 days of ICU admission and at least 1 RFcsa were available. In patients with sequential RFcsa measurements, muscle loss was defined as the negative slope of the regression line fitted to the RFcsa measurements per patient in the first 10 days of ICU admission. Correlations between baseline metabolite concentrations and baseline muscle mass, as well as between baseline metabolite concentrations and muscle loss were assessed using Pearson's test for correlations. To correct for multiple testing, the Benjamini-Hochberg procedure was used. RESULTS Seventeen patients were eligible for analysis. Mean age was 62 (SD ± 9) years and the cohort was predominantly male (76%). Four metabolites correlated with baseline muscle mass: creatinine (R = 0.5, p = 0.041), glycerophospholipid PC_ae_C30_0 (R = 0.5, p = 0.034) and two acylcarnitines: C14_2 (R = 0.5, p = 0.042) and C10_2 (R = 0.5, p = 0.049). For muscle loss, significant associations were found for histidine (R = -0.8, p = 0.002) and three glycerophospholipids; PC_aa_C40_2 (R = 0.7, p = 0.015), PC_ae_C40_1 (R = 0.6, p = 0.032) and PC_aa_C42_1 (R = 0.6, p = 0.037). After correction for multiple testing, no significant associations remained. CONCLUSIONS This exploratory analysis found certain metabolites to be associated with muscle mass and muscle loss. Future research, specifically addressing these metabolites is necessary to confirm or refute an association with muscle loss and determine their role as potential muscle loss marker.
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Affiliation(s)
- Leanne L G C Ackermans
- Department of Traumatology, Maastricht University Medical Centre, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Julia L M Bels
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands.
| | - Benjamin Seethaler
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany
| | - Maarten van Dinter
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany
| | - Marcel C G van de Poll
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, the Netherlands
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr. 12, 70599 Stuttgart, Germany
| | - Martijn Poeze
- Department of Traumatology, Maastricht University Medical Centre, the Netherlands
| | - Taco J Blokhuis
- Department of Traumatology, Maastricht University Medical Centre, the Netherlands
| | - Jan A Ten Bosch
- Department of Traumatology, Maastricht University Medical Centre, the Netherlands
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Simó-Servat A, Guevara E, Perea V, Alonso N, Quirós C, Puig-Jové C, Barahona MJ. Role of Muscle Ultrasound for the Study of Frailty in Elderly Patients with Diabetes: A Pilot Study. BIOLOGY 2023; 12:884. [PMID: 37372168 DOI: 10.3390/biology12060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Sarcopenia and diabetes contribute to the development of frailty. Therefore, accessible methods, such as muscle ultrasounds (MUSs), to screen for sarcopenia should be implemented in clinical practice. METHODS We conducted a cross-sectional pilot study including 47 patients with diabetes (mean age: 77.72 ± 5.08 years, mean weight: 75.8 kg ± 15.89 kg, and body mass index: 31.19 ± 6.65 kg/m2) categorized as frail by the FRAIL Scale or Clinical Frailty Scale and confirmed by Fried's Frailty Phenotype or Rockwood's 36-item Frailty Index. We used the SARC-F questionnaire to identify sarcopenia. The Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) tests were used to assess physical performance and the risk of falls, respectively. In addition, other variables were measured: fat-free mass (FFM) and Sarcopenia Risk Index (SRI) with the bioimpedance analysis (BIA); thigh muscle thickness (TMT) of the quadriceps with MUS; and hand-grip strength with dynamometry. RESULTS We observed correlations between the SARC-F and FFM (R = -0.4; p < 0.002) and hand-grip strength (R = -0.5; p < 0.0002), as well as between the TMT and FFM of the right leg (R = 0.4; p < 0.02) and the SRI (R = 0.6; p < 0.0001). We could predict sarcopenia using a logistic regression model with a ROC curve (AUC = 0.78) including FFM, handgrip strength, and TMT. The optimal cut-off point for maximum efficiency was 1.58 cm for TMT (sensitivity = 71.4% and specificity = 51.5%). However, we did not observe differences in the TMT among groups of greater/less frailty based on the SARC-F, SPPB, and TUG (p > 0.05). CONCLUSIONS MUSs, which correlated with the BIA (R = 0.4; p < 0.02), complemented the diagnosis, identifying regional sarcopenia of the quadriceps in frail patients with diabetes and improving the ROC curve to AUC = 0.78. In addition, a TMT cut-off point for the diagnosis of sarcopenia of 1.58 cm was obtained. Larger studies to validate the MUS technique as a screening strategy are warranted.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ernesto Guevara
- Department of Geriatrics, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - María-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
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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.
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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
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Rosa-Caldwell ME, Eddy KT, Rutkove SB, Breithaupt L. Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study. Int J Eat Disord 2023; 56:483-500. [PMID: 36529682 DOI: 10.1002/eat.23878] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Conduct a systematic review on muscle size and strength in individuals with anorexia nervosa (AN). METHOD In accordance with PRISMA guidelines, we searched Pubmed for articles published between 1995 and 2022 using a combination of search terms related to AN and muscle size, strength, or metabolism. After two authors screened articles and extracted data, 30 articles met inclusion criteria. Data were coded, and a risk bias was conducted for each study. RESULTS The majority of studies focused on muscle size/lean mass (60%, n = 18) and energy expenditure (33%, n = 9), with few studies (17%, n = 5) investigating muscle function or possible mechanisms underlying muscle size (20%, n = 6). Studies supported that individuals with AN have smaller muscle size and reduced energy expenditure relative to controls. In some studies (33%, n = 10) recovery from AN was not sufficient to restore muscle mass or function. Mechanisms underlying short and long-term musculoskeletal alterations have not been thoroughly explored. DISCUSSION Muscle mass and strength loss may be an unexplored component of physiological deterioration during and after AN. More research is necessary to understand intramuscular alterations during AN and interventions to facilitate muscle mass and functional gain following weight restoration in AN. PUBLIC SIGNIFICANCE Muscle health is important for optimal health and is reduced in individuals with AN. However, we do not understand how muscle is altered at the cellular level throughout the course of AN. Here we review what is currently known regarding muscle health during AN and with weight restoration.
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Affiliation(s)
- Megan E Rosa-Caldwell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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27
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Bao X, Zhang Q, Fragnito N, Wang J, Sharma N. A clustering-based method for estimating pennation angle from B-mode ultrasound images. WEARABLE TECHNOLOGIES 2023; 4:e6. [PMID: 38487764 PMCID: PMC10936288 DOI: 10.1017/wtc.2022.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/08/2022] [Accepted: 11/25/2022] [Indexed: 03/17/2024]
Abstract
B-mode ultrasound (US) is often used to noninvasively measure skeletal muscle architecture, which contains human intent information. Extracted features from B-mode images can help improve closed-loop human-robotic interaction control when using rehabilitation/assistive devices. The traditional manual approach to inferring the muscle structural features from US images is laborious, time-consuming, and subjective among different investigators. This paper proposes a clustering-based detection method that can mimic a well-trained human expert in identifying fascicle and aponeurosis and, therefore, compute the pennation angle. The clustering-based architecture assumes that muscle fibers have tubular characteristics. It is robust for low-frequency image streams. We compared the proposed algorithm to two mature benchmark techniques: UltraTrack and ImageJ. The performance of the proposed approach showed higher accuracy in our dataset (frame frequency is 20 Hz), that is, similar to the human expert. The proposed method shows promising potential in automatic muscle fascicle orientation detection to facilitate implementations in biomechanics modeling, rehabilitation robot control design, and neuromuscular disease diagnosis with low-frequency data stream.
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Affiliation(s)
- Xuefeng Bao
- Department of Biomedical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Qiang Zhang
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, The University of North Carolina, Chapel Hill, NC, USA
| | - Natalie Fragnito
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, The University of North Carolina, Chapel Hill, NC, USA
| | | | - Nitin Sharma
- Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, The University of North Carolina, Chapel Hill, NC, USA
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De Rosa S, Umbrello M, Pelosi P, Battaglini D. Update on Lean Body Mass Diagnostic Assessment in Critical Illness. Diagnostics (Basel) 2023; 13:diagnostics13050888. [PMID: 36900032 PMCID: PMC10000858 DOI: 10.3390/diagnostics13050888] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023] Open
Abstract
Acute critical illnesses can alter vital functions with profound biological, biochemical, metabolic, and functional modifications. Despite etiology, patient's nutritional status is pivotal to guide metabolic support. The assessment of nutritional status remains complex and not completely elucidated. Loss of lean body mass is a clear marker of malnutrition; however, the question of how to investigate it still remains unanswered. Several tools have been implemented to measure lean body mass, including a computed tomography scan, ultrasound, and bioelectrical impedance analysis, although such methods unfortunately require validation. A lack of uniform bedside measurement tools could impact the nutrition outcome. Metabolic assessment, nutritional status, and nutritional risk have a pivotal role in critical care. Therefore, knowledge about the methods used to assess lean body mass in critical illnesses is increasingly required. The aim of the present review is to update the scientific evidence regarding lean body mass diagnostic assessment in critical illness to provide the diagnostic key points for metabolic and nutritional support.
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Affiliation(s)
- Silvia De Rosa
- Centre for Medical Sciences—CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, 38123 Trento, Italy
| | - Michele Umbrello
- S.C. Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST dei Santi Paolo e Carlo, 20142 Milano, Italy
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, 16132 Genova, Italy
| | - Denise Battaglini
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Correspondence:
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Association of Sonographic Sarcopenia and Falls in Older Adults Presenting to the Emergency Department. J Clin Med 2023; 12:jcm12041251. [PMID: 36835787 PMCID: PMC9968231 DOI: 10.3390/jcm12041251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To determine the association between point-of-care-ultrasonography (POCUS)-measured sarcopenia and grip strength, as well as the history of prior-year falls among older adults admitted to the emergency department observation unit (EDOU). MATERIALS AND METHODS This cross-sectional observational study was conducted over 8 months at a large urban teaching hospital. A consecutive sample of patients who were 65 years or older and admitted to the EDOU were enrolled in the study. Using standardized techniques, trained research assistants and co-investigators measured patients' biceps brachii and thigh quadriceps muscles via a linear transducer. Grip strength was measured using a Jamar Hydraulic Hand Dynamometer. Participants were surveyed regarding their history of falls in the prior year. Logistic regression analyses assessed the relationship of sarcopenia and grip strength to a history of falls (the primary outcome). RESULTS Among 199 participants (55% female), 46% reported falling in the prior year. The median biceps thickness was 2.22 cm with an Interquartile range [IQR] of 1.87-2.74, and the median thigh muscle thickness was 2.91 cm with an IQR of 2.40-3.49. A univariate logistic regression analysis demonstrated a correlation between higher thigh muscle thickness, normal grip strength, and history of prior-year falling, with an odds ratio [OR] of 0.67 (95% conference interval [95%CI] 0.47-0.95) and an OR of 0.51 (95%CI 0.29-0.91), respectively. In multivariate logistic regression, only higher thigh muscle thickness was correlated with a history of prior-year falls, with an OR of 0.59 (95% CI 0.38-0.91). CONCLUSIONS POCUS-measured thigh muscle thickness has the potential to identify patients who have fallen and thus are at high risk for future falls.
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García-Almeida JM, García-García C, Ballesteros-Pomar MD, Olveira G, Lopez-Gomez JJ, Bellido V, Bretón Lesmes I, Burgos R, Sanz-Paris A, Matia-Martin P, Botella Romero F, Ocon Breton J, Zugasti Murillo A, Bellido D. Expert Consensus on Morphofunctional Assessment in Disease-Related Malnutrition. Grade Review and Delphi Study. Nutrients 2023; 15:nu15030612. [PMID: 36771319 PMCID: PMC9920608 DOI: 10.3390/nu15030612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Disease-related malnutrition (DRM) affects approximately a third of hospitalized patients and is associated with an increased risk of morbimortality. However, DRM is often underdiagnosed and undertreated. Our aim is to evaluate the prognostic value of morphofunctional tools and tests for nutritional assessment in clinical practice. A systematic literature review was conducted to identify studies relating to the morphofunctional assessment of nutritional status and mortality or complications. Evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) method. Twelve GRADE recommendations were made and divided into seven topics: food intake and nutrient assimilation, anthropometry, biochemical analysis, hand grip strength, phase angle, muscle imaging, and functional status and quality of life. From these recommendations, 37 statements were developed and scored in a two-survey Delphi method by 183 experts. A consensus was reached on accepting 26/37 statements. Surveys had high internal consistency and high inter-rater reliability. In conclusion, evidence-based recommendations were made on the prognostic value of morphofunctional assessment tools and tests to assess malnutrition, most of which were found to be feasible in routine clinical practice, according to expert opinions.
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Affiliation(s)
- José Manuel García-Almeida
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- CIBEROBN, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición, 28029 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Quirónsalud, 29004 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
| | - Cristina García-García
- PhD Program in Biomedicine, Translational Research and New Health Technologies, Faculty of Medicine, University of Málaga, 29071 Málaga, Spain
- Medical Director, Persan Farma, 35007 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.: +34-670326887
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Gabriel Olveira
- IBIMA, Instituto de Investigación Biomédica y Plataforma en Nanomedicina, BIONAND, 29590 Málaga, Spain
- Facultad de Medicina, University of Málaga, 29010 Málaga, Spain
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 29010 Málaga, Spain
- Department of Medicine and Dermatology, University of Málaga, 29016 Málaga, Spain
| | - Juan J. Lopez-Gomez
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Irene Bretón Lesmes
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Rosa Burgos
- Nutritional Support Unit, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Pilar Matia-Martin
- Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Medicine Department, Universidad Complutense, 28040 Madrid, Spain
| | - Francisco Botella Romero
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Albacete, 02006 Albacete, Spain
| | - Julia Ocon Breton
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Ana Zugasti Murillo
- Nutrition Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Diego Bellido
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Ferrol, 15405 Ferrol, Spain
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Barba C, Downer B, Clay OJ, Kennedy R, Ballard E, Crowe M. Healthcare utilization among pre-frail and frail Puerto Ricans. PLoS One 2023; 18:e0280128. [PMID: 36634091 PMCID: PMC9836292 DOI: 10.1371/journal.pone.0280128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.
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Affiliation(s)
- Cheyanne Barba
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Brian Downer
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch, Birmingham, Alabama, Unites States of America
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, & Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Erin Ballard
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Unites States of America
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Wang L, Lin X, Huang H, Wang Y, Liang X, Zheng X, Xu L. Low rectus femoris mass index is closely associated with diabetic peripheral neuropathy. Front Endocrinol (Lausanne) 2023; 14:1148093. [PMID: 37152962 PMCID: PMC10160655 DOI: 10.3389/fendo.2023.1148093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Aims To assess the association of rectus femoris mass index (RFMI) with diabetic peripheral neuropathy (DPN) in individuals with type 2 diabetes mellitus (T2DM). Methods Totally 948 T2DM cases were enrolled. Nerve conduction parameters, quantitative sensory threshold and rectus femoris cross-sectional area (RFCSA) were obtained, and rectus femoris mass index (RFMI=RFCSA/height2) was derived. The patients were assigned to four groups based on interquartile spacing of RFMI. Results Motor/sensory nerve amplitude and conduction velocity (CV) were significantly lower in the low-level RFMI groups (all P<0.05). RFMI was positively associated with mean motor/sensory nerve amplitude and CV (both P<0.05). T2DM duration above 10 years and RFMI below 2.37cm²/m² had significant associations with DPN (both P<0.001). Receiver operating characteristic (ROC) curve analysis demonstrated cutoffs for T2DM duration and RFMI of 7 years and 2.2 cm²/m², respectively (AUC=0.75, 95% CI: 0.72-0.79; sensitivity, 68.4%; specificity, 66.8%). Conclusion DPN is significantly associated with reduced RFMI in T2DM patients. Decreased muscle mass seems to be associated with motor/sensory nerve amplitude and CV. RFMI combined with T2DM duration may represent a potent tool for predicting DPN occurrence in T2DM cases. Clinical trial registration http://www.chictr.org.cn, identifier ChiCTR2100049150.
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Affiliation(s)
- Lina Wang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaopu Lin
- Department of Huiqiao Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haishan Huang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanfang Wang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xinxin Liang
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaobin Zheng
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingling Xu
- Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Lingling Xu,
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Peres LM, Luis-Silva F, Menegueti MG, Sato L, Basile-Filho A, Suen VMM, Martins-Filho OA, Auxiliadora-Martins M. Comparison of ultrasound with computed tomography to measure skeletal muscle mass in critically ill patients: A prospective study protocol. Medicine (Baltimore) 2022; 101:e31921. [PMID: 36482563 PMCID: PMC9726332 DOI: 10.1097/md.0000000000031921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Therapy and nutritional status directly interfere in the clinical evolution of critically ill patients, in reducing morbidity and mortality, by maintaining the functional integrity of the gastrointestinal tract, decreasing the catabolic response, besides contributing to the reduction of hospitalization time resulting in less treatment cost. Critical patients and trauma victims suffer early changes in the quantity and quality of muscle mass. Tools to identify the groups most susceptible to these complications are necessary so that interventions can minimize the deleterious effects of malnutrition in critically ill patients. METHODS AND ANALYSIS The aim of the present study is to measure muscle mass loss by measuring the thickness of the rectus femoris muscle by bedside ultrasound in critically ill patients admitted to the Intensive Care Unit (ICU) of a university hospital. Information will be collected regarding the length of hospital and ICU stay, the reason for admission, anthropometric data at admission and during hospitalization, energy needs, nutritional therapy used, and fasting time. This is a prospective, observational study that will be carried out in a single center in an ICU of a tertiary university hospital. The study population will undergo 3 tomographic images and 3 ultrasounds of the rectus femoris of each patient at different times. We propose, unprecedentedly, performing a validation study of ultrasound with the gold standard Computed tomography to evaluate the musculature of critically ill patients victims of traumatic brain injury. The results got will texto be fundamental for the development of new fields of investigation and certainly contribute to the discovery of a new approach to treat sarcopenia in critically ill patients. The Research Ethics Committee approved the study and all patients included will sign an informed consent form. (Clinical Record: RBR-2bzspnz).
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Affiliation(s)
- Leandro Moreira Peres
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- * Correspondence: Leandro Moreira Peres, Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, ABandeirantes, Ribeirão Preto 14048900, Brazil (e-mail: )
| | - Fabio Luis-Silva
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Lucas Sato
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Vivian Marques Miguel Suen
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Maria Auxiliadora-Martins
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Hardy EJO, Inns TB, Hatt J, Doleman B, Bass JJ, Atherton PJ, Lund JN, Phillips BE. The time course of disuse muscle atrophy of the lower limb in health and disease. J Cachexia Sarcopenia Muscle 2022; 13:2616-2629. [PMID: 36104842 PMCID: PMC9745468 DOI: 10.1002/jcsm.13067] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Short, intermittent episodes of disuse muscle atrophy (DMA) may have negative impact on age related muscle loss. There is evidence of variability in rate of DMA between muscles and over the duration of immobilization. As yet, this is poorly characterized. This review aims to establish and compare the time-course of DMA in immobilized human lower limb muscles in both healthy and critically ill individuals, exploring evidence for an acute phase of DMA and differential rates of atrophy between and muscle groups. MEDLINE, Embase, CINHAL and CENTRAL databases were searched from inception to April 2021 for any study of human lower limb immobilization reporting muscle volume, cross-sectional area (CSA), architecture or lean leg mass over multiple post-immobilization timepoints. Risk of bias was assessed using ROBINS-I. Where possible meta-analysis was performed using a DerSimonian and Laird random effects model with effect sizes reported as mean differences (MD) with 95% confidence intervals (95% CI) at various time-points and a narrative review when meta-analysis was not possible. Twenty-nine studies were included, 12 in healthy volunteers (total n = 140), 18 in patients on an Intensive Therapy Unit (ITU) (total n = 516) and 3 in patients with ankle fracture (total n = 39). The majority of included studies are at moderate risk of bias. Rate of quadriceps atrophy over the first 14 days was significantly greater in the ITU patients (MD -1.01 95% CI -1.32, -0.69), than healthy cohorts (MD -0.12 95% CI -0.49, 0.24) (P < 0.001). Rates of atrophy appeared to vary between muscle groups (greatest in triceps surae (-11.2% day 28), followed by quadriceps (-9.2% day 28), then hamstrings (-6.5% day 28), then foot dorsiflexors (-3.2% day 28)). Rates of atrophy appear to decrease over time in healthy quadriceps (-6.5% day 14 vs. -9.1% day 28) and triceps surae (-7.8% day 14 vs. -11.2% day 28), and ITU quadriceps (-13.2% day 7 vs. -28.2% day 14). There appears to be variability in the rate of DMA between muscle groups, and more rapid atrophy during the earliest period of immobilization, indicating different mechanisms being dominant at different timepoints. Rates of atrophy are greater amongst critically unwell patients. Overall evidence is limited, and existing data has wide variability in the measures reported. Further work is required to fully characterize the time course of DMA in both health and disease.
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Affiliation(s)
- Edward J O Hardy
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Thomas B Inns
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jacob Hatt
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Brett Doleman
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,Department of Anaesthetics, Royal Derby Hospital, Derby, UK
| | - Joseph J Bass
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Philip J Atherton
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jonathan N Lund
- Department of General Surgery, Royal Derby Hospital, Derby, UK.,Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK
| | - Bethan E Phillips
- Centre Of Metabolism, Ageing and Physiology (COMAP), School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.,MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR) and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Ritsche P, Wirth P, Cronin NJ, Sarto F, Narici MV, Faude O, Franchi MV. DeepACSA: Automatic Segmentation of Cross-Sectional Area in Ultrasound Images of Lower Limb Muscles Using Deep Learning. Med Sci Sports Exerc 2022; 54:2188-2195. [PMID: 35941517 DOI: 10.1249/mss.0000000000003010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Muscle anatomical cross-sectional area (ACSA) can be assessed using ultrasound and images are usually evaluated manually. Here, we present DeepACSA, a deep learning approach to automatically segment ACSA in panoramic ultrasound images of the human rectus femoris (RF), vastus lateralis (VL), gastrocnemius medialis (GM) and lateralis (GL) muscles. METHODS We trained three muscle-specific convolutional neural networks (CNN) using 1772 ultrasound images from 153 participants (age = 38.2 yr, range = 13-78). Images were acquired in 10% increments from 30% to 70% of femur length for RF and VL and at 30% and 50% of muscle length for GM and GL. During training, CNN performance was evaluated using intersection-over-union scores. We compared the performance of DeepACSA to manual analysis and a semiautomated algorithm using an unseen test set. RESULTS Comparing DeepACSA analysis of the RF to manual analysis with erroneous predictions removed (3.3%) resulted in intraclass correlation (ICC) of 0.989 (95% confidence interval = 0.983-0.992), mean difference of 0.20 cm 2 (0.10-0.30), and SEM of 0.33 cm 2 (0.26-0.41). For the VL, ICC was 0.97 (0.96-0.968), mean difference was 0.85 cm 2 (-0.4 to 1.31), and SEM was 0.92 cm 2 (0.73-1.09) after removal of erroneous predictions (7.7%). After removal of erroneous predictions (12.3%), GM/GL muscles demonstrated an ICC of 0.98 (0.96-0.99), a mean difference of 0.43 cm 2 (0.21-0.65), and an SEM of 0.41 cm 2 (0.29-0.51). Analysis duration was 4.0 ± 0.43 s (mean ± SD) for analysis of one image in our test set using DeepACSA. CONCLUSIONS DeepACSA provides fast and objective segmentation of lower limb panoramic ultrasound images comparable with manual segmentation. Inaccurate model predictions occurred predominantly on low-quality images, highlighting the importance of high-quality image for accurate prediction.
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Affiliation(s)
- Paul Ritsche
- Department of Sport, Exercise and Health, University of Basel, Basel, SWITZERLAND
| | | | - Neil J Cronin
- Neuromuscular Research Centre, Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, FINLAND
| | - Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, ITALY
| | | | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, SWITZERLAND
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Cornejo-Pareja I, Soler-Beunza AG, Vegas-Aguilar IM, Fernández-Jiménez R, Tinahones FJ, García-Almeida JM. Predictors of Sarcopenia in Outpatients with Post-Critical SARS-CoV2 Disease. Nutritional Ultrasound of Rectus Femoris Muscle, a Potential Tool. Nutrients 2022; 14:nu14234988. [PMID: 36501018 PMCID: PMC9740630 DOI: 10.3390/nu14234988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: The loss of muscle mass in post-critical COVID-19 outpatients is difficult to assess due to the limitations of techniques and the high prevalence of obesity. Ultrasound is an emerging technique for evaluating body composition. The aim is to evaluate sarcopenia and its risk factors, determining ultrasound usefulness as a potential tool for this purpose according to established techniques, such as the bioimpedance vector analysis (BIVA), handgrip strength, and timed up-and-go test. Methods: This is a transversal study of 30 post-critical COVID-19 outpatients. We evaluated nutritional status by ultrasound (Rectus Femoris-cross-sectional-area (RF-CSA), thickness, and subcutaneous-adipose-tissue), BIVA, handgrip strength, timed up-and-go test, and clinical variables during admission. Results: According to The European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity (ESPEN&EASO) Consensus for Sarcopenic and Obesity, in terms of excess fat mass and decreased lean mass, the prevalence of class-1 sarcopenic obesity was 23.4% (n = 7), and class-2 sarcopenic obesity was 33.3% (n = 10) in our study. A total of 46.7% (n = 14) of patients had a handgrip strength below the 10th percentile, and 30% (n = 9) achieved a time greater than 10s in the timed up-and-go test. There were strong correlations between the different techniques that evaluated the morphological (BIVA, Ultrasound) and functional measurements of muscle. Intensive care unit stay, mechanical ventilation, and age all conditioned the presence of sarcopenia in COVID-19 outpatients (R2 = 0.488, p = 0.002). Predictive models for sarcopenic diagnosis based on a skeletal muscle index estimation were established by RF-CSA (R2 0.792, standard error of estimate (SEE) 1.10, p < 0.001), muscle-thickness (R2 0.774, SEE 1.14, p < 0.001), and handgrip strength (R2 0.856, SEE 0.92, p < 0.001). RF-CSA/weight of 5.3 cm2/kg × 100 was the cut-off value for predicting sarcopenia in post-critical COVID-19 outpatients, with 88.2 sensitivity and 69.2% specificity. Conclusion: More than half of the post-critical COVID-19 survivors had sarcopenic obesity and functional impairment of handgrip strength. Intensive care unit stay, age, and mechanical ventilation all predict sarcopenia. An ultrasound, when applied to the assessment of body composition in post-critical COVID-19 patients, provided the possibility of assessing sarcopenia in this population.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigacion Biomedica en Red de la Fisiopatología de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 29010 Malaga, Spain
- Correspondence: (I.C.-P.); (F.J.T.)
| | - Ana Gloria Soler-Beunza
- Department of Endocrinology and Nutrition, Arnau de Villanova University Hospital, 25198 Lleida, Spain
| | - Isabel María Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga University, 29010 Málaga, Spain
| | - Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga University, 29010 Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga University, 29010 Málaga, Spain
- Correspondence: (I.C.-P.); (F.J.T.)
| | - Jose Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga University, 29010 Málaga, Spain
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Meza-Valderrama D, Marco E, Muñoz-Redondo E, Morgado-Pérez A, Sánchez MT, Curbelo Peña Y, De Jaime E, Canchucaja L, Meza Concepción F, Perkisas S, Sánchez-Rodríguez D. Musculoskeletal Ultrasound Shows Muscle Mass Changes during Post-Acute Care Hospitalization in Older Men: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15150. [PMID: 36429869 PMCID: PMC9690008 DOI: 10.3390/ijerph192215150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to prospectively assess changes in muscle thickness (MT) and the cross-sectional area (CSA) of the rectus femoris (RF) muscle in a cohort of older adults, using musculoskeletal ultrasound at admission and at a 2-week follow-up during hospitalization in a post-acute care unit. Differences in frailty status and correlations of MT-RF and CSA-RF with current sarcopenia diagnostic criteria were also studied. Forty adults aged 79.5 (SD 9.5) years (57.5% women) participated, including 14 with frailty and 26 with pre-frailty. In the first week follow-up, men had a significant increase in MT (0.9 mm [95%CI 0.3 to 1.4], p = 0.003) and CSA (0.4 cm2 [95%CI 0.1 to 0.6], p = 0.007). During the second week, men continued to have a significant increase in MT (0.7 mm [95%CI 0.0 to 1.4], p = 0.036) and CSA (0.6 cm2 [95%CI 0.01 to 1.2], p = 0.048). Patients with frailty had lower values of MT-RF and CSA-RF at admission and during the hospitalization period. A moderate-to-good correlation of MT-RF and CSA with handgrip strength, fat-free mass and gait speed was observed. Musculoskeletal ultrasound was able to detect MT-RF and CSA-RF changes in older adults admitted to a post-acute care unit.
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Affiliation(s)
- Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Vía Centenario, Diagonal a la Universidad Tecnológica de Panamá, Panama City 0819, Panama
- Physical Medicine and Rehabilitation Department, Caja de Seguro Social, Calle de Circunvalación, Panama City 0844, Panama
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
- School of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Catalonia, Spain
| | - Elena Muñoz-Redondo
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Andrea Morgado-Pérez
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Marta Tejero Sánchez
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Yulibeth Curbelo Peña
- Rehabilitation Research Group, Hospital del Mar Research Institute, Dr. Aiguader, 88, 08003 Barcelona, Catalonia, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l’Esperança), Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Elisabeth De Jaime
- Geriatric Department, Centre Fòrum-Hospital del Mar, Parc de Salut Mar, Llull, 410, 08029 Barcelona, Catalonia, Spain
| | - Lizzeth Canchucaja
- Geriatric Department, Centre Fòrum-Hospital del Mar, Parc de Salut Mar, Llull, 410, 08029 Barcelona, Catalonia, Spain
| | - Frank Meza Concepción
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja de Seguro Social, Ave. Simón Bolívar, Panama City 07096, Panama
| | - Stany Perkisas
- University Center of Geriatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
- First Line and Interdisciplinary Care Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Dolores Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Place du 20 Août 7, 4000 Liege, Belgium
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Fuest KE, Lanz H, Schulz J, Ulm B, Bennett VA, Grunow JJ, Weiss B, Blobner M, Schaller SJ. Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients. J Intensive Care Med 2022; 38:431-439. [PMID: 36227022 PMCID: PMC10154988 DOI: 10.1177/08850666221132246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Muscle ultrasound represents a promising approach to aid diagnoses of neuromuscular diseases in critically ill patients. Unfortunately, standardization of ultrasound measurements in clinical research is lacking, making direct comparisons between studies difficult. Protocols are required to assess qualitative muscle changes during an ICU stay in patients at high risk for the development of neuromuscular acquired weakness (ICUAW). METHODS We conducted a retrospective, observational analysis comprised of three prospective observational studies with the aim of diagnosing muscle changes by ultrasound measurement of the quadriceps muscle. Different protocols were used in each of the three studies. In total, 62 surgical, neurocritical care and trauma intensive care patients were serially assessed by different ultrasound protocols during the first week of critical illness. The relative change in ultrasound measurements was calculated for all possible locations, methods and sides. Comparison was obtained using mixed effect models with the location, the height and the side as influencing variables and patients as fixed effect. The relationship between variables and outcomes was assessed by multivariable regression analysis. RESULTS Ultrasound methods and measurement sites of the quadriceps muscles from all protocols were equally effective in detecting muscle changes. During the first week of an ICU stay, two groups were identified: patients with decreased muscle mass on ultrasound (n = 42) and a cohort with enlargement (n = 23). Hospital mortality was significantly increased in the cohort with muscle swelling (8 (19%) versus 12 (52%), p = .013). CONCLUSIONS Different approaches of ultrasound measurement during critical-illness are equally able to detect muscle changes. While some patients have a decrease in muscle mass, others show swelling, which may result in a reduced probability of surviving the hospital stay. Causative reasons for these results still remain unclear.
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Affiliation(s)
- Kristina E Fuest
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Hugo Lanz
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Jana Schulz
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Bernhard Ulm
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Victoria A Bennett
- Adult Critical Care Unit, 112001Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
| | - Björn Weiss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
| | - Manfred Blobner
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany.,Adult Critical Care Unit, 112001Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stefan J Schaller
- Technical University of Munich, 9184School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Berlin, Germany
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Casey P, Alasmar M, McLaughlin J, Ang Y, McPhee J, Heire P, Sultan J. The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review. J Cachexia Sarcopenia Muscle 2022; 13:2298-2309. [PMID: 35851996 PMCID: PMC9530572 DOI: 10.1002/jcsm.13041] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/21/2022] [Accepted: 06/25/2022] [Indexed: 11/06/2022] Open
Abstract
Quantification and monitoring of lean body mass is an important component of nutrition assessment to determine nutrition status and muscle loss. The negative impact of reduced muscle mass and muscle function is increasingly evident across acute and chronic disease states but is particularly pronounced in patients with cancer. Ultrasound is emerging as a promising tool to directly measure skeletal muscle mass and quality. Unlike other ionizing imaging techniques, ultrasound can be used repeatedly at the bedside and may compliment nutritional risk assessment. This review aims to describe the current use of skeletal muscle ultrasound (SMUS) to measure muscle mass and quality in patients with acute and chronic clinical conditions and its ability to predict functional capacity, severity of malnutrition, hospital admission, and survival. Databases were searched from their inception to August 2021 for full-text articles in English. Relevant articles were included if SMUS was investigated in acute or chronic clinical contexts and correlated with a defined clinical outcome measure. Data were synthesized for narrative review due to heterogeneity between studies. This review analysed 37 studies (3100 patients), which met the inclusion criteria. Most studies (n = 22) were conducted in critical care. The clinical outcomes investigated included functional status at discharge (intensive care unit-acquired weakness), nutritional status, and length of stay. SMUS was also utilized in chronic conditions such as chronic obstructive pulmonary disease, chronic heart failure, and chronic renal failure to predict hospital readmission and disease severity. Only two studies investigated the use of SMUS in patients with cancer. Of the 37 studies, 28 (76%) found that SMUS (cross-sectional area, muscle thickness, and echointensity) showed significant associations with functional capacity, length of stay, readmission, and survival. There was significant heterogeneity in terms of ultrasound technique and outcome measurement across the included studies. This review highlights that SMUS continues to gain momentum as a potential tool for skeletal muscle assessment and predicting clinically important outcomes. Further work is required to standardize the technique in nutritionally vulnerable patients, such as those with cancer, before SMUS can be widely adopted as a bedside prognostic tool.
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Affiliation(s)
- Patrick Casey
- Department of Oesophagogastric SurgerySalford Royal NHS Foundation TrustSalfordUK
- Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Mohamed Alasmar
- Department of Oesophagogastric SurgerySalford Royal NHS Foundation TrustSalfordUK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Department of GastroenterologySalford Royal NHS Foundation TrustSalfordUK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Department of GastroenterologySalford Royal NHS Foundation TrustSalfordUK
| | - Jamie McPhee
- Manchester Metropolitan University Institute of SportManchesterUK
- Department of Musculoskeletal RadiologySalford Royal NHS Foundation TrustSalfordUK
| | - Priam Heire
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Javed Sultan
- Department of Oesophagogastric SurgerySalford Royal NHS Foundation TrustSalfordUK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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Vieira FN, Bertazzo RB, Nascimento GC, Anderle M, Coelho AC, Chaise FDO, Fink JDS, Nedel WL, Ziegler B. Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit. Rev Bras Ter Intensiva 2022; 34:452-460. [PMID: 36888825 PMCID: PMC9987003 DOI: 10.5935/0103-507x.20220087-pt] [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: 03/02/2022] [Accepted: 10/17/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To verify the relationship between the rectus femoris cross-sectional area and diaphragmatic excursion with successful weaning from mechanical ventilation in chronic critically tracheostomized patients. METHODS This was a prospective observational cohort study. We included chronic critically ill patients (those who underwent tracheostomy placement after 10 days under mechanical ventilation). The rectus femoris cross-sectional area and diaphragmatic excursion were obtained by ultrasonography performed within the first 48 hours after tracheostomy. We measured rectus femoris cross-sectional area and diaphragmatic excursion to assess their association with weaning from mechanical ventilation, including their potential to predict successful weaning and survival throughout the intensive care unit stay. RESULTS Eighty-one patients were included. Forty-five patients (55%) were weaned from mechanical ventilation. The mortality rates were 42% and 61.7% in the intensive care unit and hospital, respectively. The fail group in relation to the success group at weaning presented a lower rectus femoris cross-sectional area (1.4 [0.8] versus 1.84 [0.76]cm2, p = 0.014) and lower diaphragmatic excursion (1.29 ± 0.62 versus 1.62 ± 0.51cm, p = 0.019). When rectus femoris cross-sectional area ≥ 1.80cm2 and diaphragmatic excursion ≥ 1.25cm was a combined condition, it had a strong association with successful weaning (adjusted OR = 20.81, 95%CI 2.38 - 182.28; p = 0.006) but not with intensive care unit survival (adjusted OR = 0.19, 95%CI 0.03 - 1.08; p = 0.061). CONCLUSION Successful weaning from mechanical ventilation in chronic critically ill patients was associated with higher measurements of rectus femoris cross-sectional area and diaphragmatic excursion.
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Affiliation(s)
- Fernando Nataniel Vieira
- Postgraduate Porgram in Pulmonological Sciences, Universidade
Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | - Raquel Bortoluzzi Bertazzo
- Postgraduate Porgram in Pulmonological Sciences, Universidade
Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | - Mariluce Anderle
- Intensive Care Unit, Grupo Hospitalar Conceição - Porto Alegre
(RS), Brazil
| | - Ana Cláudia Coelho
- Physiotherapy Unit, Hospital de Clínicas de Porto Alegre,
Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
| | | | | | - Wagner Luis Nedel
- Intensive Care Unit, Grupo Hospitalar Conceição - Porto Alegre
(RS), Brazil
| | - Bruna Ziegler
- Postgraduate Porgram in Pulmonological Sciences, Universidade
Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil
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41
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Chen YL, Liu PT, Chiang HK, Lee SH, Lo YL, Yang YC, Chiou HJ. Ultrasound Measurement of Rectus Femoris Muscle Parameters for Discriminating Sarcopenia in Community-Dwelling Adults. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2269-2277. [PMID: 34873739 DOI: 10.1002/jum.15913] [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: 05/27/2021] [Revised: 10/31/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Sarcopenia patients require more medical attention and caretaking. As such, early detection of sarcopenia and appropriate interventions are crucial for decreasing medical costs and meeting the challenges of aging populations. The aim of the present study was to develop a reliable and accurate model to estimate muscle mass using ultrasound-derived parameters from the rectus femoris (RF), referenced by dual-energy X-ray absorptiometry. METHODS Cross-sectional study was performed. The study patients were recruited by Taipei Veterans General Hospital (No. 2016-07-013C) between 2016 and 2019. A total of 91 community-dwelling adults (35 men and 56 women) were enrolled in this study. Ultrasound measurements of RF muscle thickness (MT), cross-sectional area (CSA), and muscle volume (MV) were performed in B-mode. Muscle strength and physical performance were also examined. Multivariate linear regression was used to build models for the prediction of appendicular skeletal muscle index (ASMI) based on MT, CSA, and MV values. The accuracy of ultrasound RF measurements for predicting sarcopenia was evaluated by using receiver operating characteristic (ROC) curve analysis. RESULTS The regression equations used for ASMI prediction (adjusted body mass index, sex, and leg length) had high precision and low error. Moreover, the MV model results were close to those of the CSA model and higher than those of the MT model. The ROC analysis showed that both MV and CSA had excellent discrimination when assessing sarcopenia (AUC = 0.83 and 0.81, respectively), whereas MT showed acceptable discrimination (AUC = 0.73). CONCLUSIONS Ultrasound-derived RF MV was accurate when predicting ASMI and diagnosing sarcopenia in community-dwelling adults.
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Affiliation(s)
- Yen-Lung Chen
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Ta Liu
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
| | - Huihua K Chiang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Si-Huei Lee
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Li Lo
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yueh-Cheng Yang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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Sánchez-Torralvo FJ, Porras N, Ruiz-García I, Maldonado-Araque C, García-Olivares M, Girón MV, Gonzalo-Marín M, Olveira C, Olveira G. Usefulness of Muscle Ultrasonography in the Nutritional Assessment of Adult Patients with Cystic Fibrosis. Nutrients 2022; 14:3377. [PMID: 36014883 PMCID: PMC9415857 DOI: 10.3390/nu14163377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Muscle ultrasonography of the quadriceps rectus femoris (QRF) is a technique on the rise in the assessment of muscle mass in application of nutritional assessment. The aim of the present study is to assess the usefulness of muscle ultrasonography in patients with cystic fibrosis, comparing the results with other body composition techniques such as anthropometry, bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DXA), and handgrip strength (HGS). At the same time, we intend to assess the possible association with the nutritional and respiratory status. Methods: This was a prospective observational study in adult patients with cystic fibrosis in a clinically stable situation. Muscle ultrasonography of the QRF was performed, and the results were compared with other measures of body composition: anthropometry, BIA, and DXA. HGS was used to assess muscle function. Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 48 patients were included, with a mean age of 34.1 ± 8.8 years. In total, 24 patients were men, and 24 patients were women. Mean BMI was 22.5 ± 3.8 kg/m2. Mean muscular area rectus anterior (MARA) was 4.09 ± 1.5 cm2, and mean muscular circumference rectus was 8.86 ± 1.61 cm. A positive correlation was observed between the MARA and fat-free mass index (FFMI) determined by anthropometry (r = 0.747; p < 0.001), BIA (r = 0.780; p < 0.001), and DXA (r = 0.678; p < 0.001), as well as muscle function (HGS: r = 0.790; p < 0.001) and respiratory parameters (FEV1; r = 0.445, p = 0.005; FVC: r = 0.376, p = 0.02; FEV1/FVC: r = 0.344, p = 0.037). A total of 25 patients (52.1%) were diagnosed with malnutrition according to GLIM criteria. Differences were observed when comparing the MARA based on the diagnosis of malnutrition (4.75 ± 1.65 cm2 in normo-nourished vs. 3.37 ± 1.04 in malnourished; p = 0.014). Conclusions: In adults with cystic fibrosis, the measurements collected by muscle ultrasound of the QRF correlate adequately with body composition techniques such as anthropometry, BIA, DXA, and handgrip strength. Muscle ultrasound measurements, particularly the MARA, are related to the nutritional status and respiratory function of these patients.
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Affiliation(s)
- Francisco José Sánchez-Torralvo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
| | - Nuria Porras
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - Ignacio Ruiz-García
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
| | - Cristina Maldonado-Araque
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
| | - María García-Olivares
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - María Victoria Girón
- Unidad de Gestión Clínica de Neumología, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Montserrat Gonzalo-Marín
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
| | - Casilda Olveira
- Unidad de Gestión Clínica de Neumología, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Ultrasonografically-Assessed Osteosarcopenic Obesity is Associated With Frailty In Community-Dwelling Older Adults. Nutrition 2022; 103-104:111827. [DOI: 10.1016/j.nut.2022.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/22/2022]
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Mirón Mombiela R, Borrás C. The Usefulness of Radiomics Methodology for Developing Descriptive and Prognostic Image-Based Phenotyping in the Aging Population: Results From a Small Feasibility Study. FRONTIERS IN AGING 2022; 3:853671. [PMID: 35821818 PMCID: PMC9261370 DOI: 10.3389/fragi.2022.853671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 12/25/2022]
Abstract
Background: Radiomics is an emerging field that translates medical images into quantitative data to enable phenotypic profiling of human disease. In this retrospective study, we asked whether it is possible to use image-based phenotyping to describe and determine prognostic factors in the aging population. Methods: A radiomic frailty cohort with 101 patients was included in the analysis (65 ± 15 years, 55 men). A total of 44 texture features were extracted from the segmented muscle area of the ultrasound images of the anterior thigh. Univariate and multivariate analyses were performed to assess the image data sets and clinical data. Results: Our results showed that the heterogeneity of muscle was associated with an increased incidence of hearing impairment, stroke, myocardial infarction, dementia/memory loss, and falls in the following two years. Regression analysis revealed a muscle radiomic model with 87.1% correct predictive value with good sensitivity and moderate specificity (p = 0.001). Conclusion: It is possible to develop and identify image-based phenotypes in the elderly population. The muscle radiomic model needs to further be validated. Future studies correlated with biological data (genomics, transcriptomics, metabolomics, etc.) will give further insights into the biological basis and molecular processes of the developed radiomic model.
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Affiliation(s)
| | - Consuelo Borrás
- Freshage Research Group, Department of Physiology, Faculty of Medicine, Institute of Health Research-INCLIVA, University of Valencia, and CIBERFES, Valencia, Spain
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Bencivenga L, Picaro F, Ferrante L, Komici K, Ruggiero F, Sepe I, Gambino G, Femminella GD, Vitale DF, Ferrara N, Rengo C, Rengo G. Muscle Ultrasound as Imaging Domain of Frailty. Front Med (Lausanne) 2022; 9:922345. [PMID: 35899217 PMCID: PMC9309884 DOI: 10.3389/fmed.2022.922345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Frailty is a geriatric syndrome, a clinical state of vulnerability for developing dependency and/or death. Due to its multidimensional nature, Comprehensive Geriatric Assessment (CGA) constitutes the best strategy to evaluate frailty in older patients. Accumulation of deficits model synthesizes the global assessment of geriatric domains in the Frailty Index (FI) score. Muscle Ultrasound (MUS) has been employed to evaluate muscle mass wasting as tool to assess sarcopenia in late life. The present study aims to evaluate the association between CGA-based FI and MUS measures in a population of hospitalized older adults. Methods Patients aged ≥65 years underwent CGA for the evaluation of the domains of health and functional status, psycho-cognition, nutritional status, socio-environmental condition. Following standard procedure, a CGA-based FI was elaborated, taking into account 38 multidimensional items. Muscle thicknesses (MT) of rectus femoris plus vastus intermedius were measured through MUS axial cross-section. Multivariable regression analysis was employed to determine factors associated with FI. Results The study population consisted of 136 older patients, 87 men (63.9%), with median age of 74 (70–81) years, FI of 0.3 (0.21–0.46), and MT of rectus femoris plus vastus intermedius 29.27 (23.08–35.7) mm. At multivariable regression analysis, FI resulted significantly and independently associated with age and MT. Conclusion Muscle thicknesses of rectus femoris plus vastus intermedius, measured through MUS, resulted to be significantly related to FI in a population of hospitalized older patients. In the CGA-based assessment of frailty, MUS may constitute an additional imaging domain.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
| | - Francesco Picaro
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Lorenzo Ferrante
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Federico Ruggiero
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Immacolata Sepe
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppina Gambino
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | | | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Società Benefit, Telese, Italy
| | - Carlo Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy
- Istituti Clinici Scientifici Maugeri SpA Società Benefit, Telese, Italy
- *Correspondence: Giuseppe Rengo
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The Impact of Myosteatosis Percentage on Short-Term Mortality in Patients with Septic Shock. J Clin Med 2022; 11:jcm11113031. [PMID: 35683422 PMCID: PMC9181588 DOI: 10.3390/jcm11113031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
The impact of myosteatosis on septic patients has not been fully revealed. The aim of the study was to evaluate the impact of the myosteatosis area and percentage on the 28-day mortality in patients with septic shock. We conducted a single center, retrospective study from a prospectively collected registry of adult patients with septic shock who presented to the emergency department and performed abdominal computed tomography (CT) from May 2016 to May 2020. The myosteatosis area defined as the sum of low attenuation muscle area and intramuscular adipose tissue at the level of the third lumbar vertebra was measured by CT. Myosteatosis percentages were calculated by dividing the myosteatosis area by the total abdominal muscle area. Of the 896 patients, 28-day mortality was 16.3%, and the abnormal myosteatosis area was commonly detected (81.7%). Among variables of body compositions, non-survivors had relatively lower normal attenuation muscle area, higher low attenuation muscle area, and higher myosteatosis area and percentage than that of survivors. Trends of myosteatosis according to age group were different between the male and female groups. In subgroup analysis with male patients, the multivariate model showed that the myosteatosis percentage (adjusted OR 1.02 [95% CI 1.01–1.03]) was an independent risk factor for 28-day mortality. However, this association was not evident in the female group. Myosteatosis was common and high myosteatosis percentage was associated with short-term mortality in patients with septic shock. Our results implied that abnormal fatty disposition in muscle could impact on increased mortality, and this effect was more prominent in male patients.
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Simó-Servat A, Ibarra M, Libran M, Rodríguez S, Perea V, Quirós C, Orois A, Pérez N, Simó R, Barahona MJ. Usefulness of Muscle Ultrasound to Study Sarcopenic Obesity: A Pilot Case-Control Study. J Clin Med 2022; 11:jcm11102886. [PMID: 35629009 PMCID: PMC9143348 DOI: 10.3390/jcm11102886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background and objectives: Sarcopenic obesity (SO) is an emerging problem, especially in candidates for bariatric surgery (BS). We hypothesized that musculoskeletal ultrasound (MUS), a simple and accessible method, could be a reliable index of SO. Materials and Methods: A cross-sectional pilot study including 122 subjects (90 cases and 32 controls, 73% female, mean age: 51.2 years) who underwent BS was conducted at University Hospital Mútua Terrassa. The lean mass (LM) was calculated by bioelectrical impedance analysis (BIA) and the thigh muscle thickness (TMT) by MUS. To identify the subjects with SO by BIA, we used skeletal muscle index (SMI). The validity of MUS was determined using the ROC curve. Results: The mean BMI in the obesity group was 44.22 kg/m2. We observed a correlation between the LM and SMI assessed by BIA and the TMT assessed by MUS (R = 0.46, p < 0.001). This correlation was maintained at significant levels in the SO group (n = 40): R = 0.79; p = 0.003). The TMT assessed by MUS was able to predict SMI using BIA (AUC 0.77; 95% CI: 0.68242 to 0.84281). The optimal cut-off point for maximum efficiency was 1.57 cm in TMT (sensitivity = 75.6% and specificity = 71.1%). Conclusions: The TMT of the quadriceps assessed by US is a useful tool for identifying subjects with SO. Larger studies to validate this simple low-cost screening strategy are warranted.
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Affiliation(s)
- Andreu Simó-Servat
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
- Department of Medicine, Autonomous University of Barcelona, 08193 Bellaterra, Spain
- Correspondence: (A.S.-S.); (M.-J.B.)
| | - Montse Ibarra
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Mireia Libran
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Silvia Rodríguez
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Verónica Perea
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Aida Orois
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
| | - Noelia Pérez
- Department of General Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain;
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute and CIBERDEM (ISCIII), Autonomous University of Barcelona, 08193 Bellaterra, Spain;
| | - Maria-José Barahona
- Department of Endocrinology and Nutrition, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Spain; (M.I.); (M.L.); (S.R.); (V.P.); (C.Q.); (A.O.)
- Correspondence: (A.S.-S.); (M.-J.B.)
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Low skeletal muscle index and myosteatosis as predictors of mortality in critically ill surgical patients. Nutrition 2022; 101:111687. [DOI: 10.1016/j.nut.2022.111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
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50
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Naruse M, Trappe SW, Trappe TA. Human skeletal muscle size with ultrasound imaging: a comprehensive review. J Appl Physiol (1985) 2022; 132:1267-1279. [PMID: 35358402 PMCID: PMC9126220 DOI: 10.1152/japplphysiol.00041.2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Skeletal muscle size is an important factor in assessing adaptation to exercise training and detraining, athletic performance, age-associated atrophy and mobility decline, clinical conditions associated with cachexia, and overall skeletal muscle health. Magnetic resonance (MR) imaging and computed tomography (CT) are widely accepted as the gold standard methods for skeletal muscle size quantification. However, it is not always feasible to use these methods (e.g., field studies, bedside studies, large cohort studies). Ultrasound has been available for skeletal muscle examination for more than 50 years and the development, utility, and validity of ultrasound imaging are underappreciated. It is now possible to use ultrasound in situations where MR and CT imaging are not suitable. This review provides a comprehensive summary of ultrasound imaging and human skeletal muscle size assessment. Since the first study in 1968, more than 600 articles have used ultrasound to examine the cross-sectional area and/or volume of 107 different skeletal muscles in more than 27,500 subjects of various ages, health status, and fitness conditions. Data from these studies, supported by decades of technological developments, collectively show that ultrasonography is a valid tool for skeletal muscle size quantification. Considering the wide-ranging connections between human health and function and skeletal muscle mass, the utility of ultrasound imaging will allow it to be employed in research investigations and clinical practice in ways not previously appreciated or considered.
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Affiliation(s)
- Masatoshi Naruse
- Human Performance Laboratory, Ball State University, Muncie, IN, United States
| | - Scott W Trappe
- Human Performance Laboratory, Ball State University, Muncie, IN, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, IN, United States
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