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Herault A, Lévêque E, Draye-Carbonnier S, Decazes P, Zduniak A, Modzelewski R, Libraire J, Achamrah N, Ménard AL, Lenain P, Contentin N, Grall M, Leprêtre S, Lemasle E, Lanic H, Alani M, Stamatoullas-Bastard A, Tilly H, Jardin F, Tamion F, Camus V. High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock. Clin Nutr ESPEN 2023; 55:373-383. [PMID: 37202070 DOI: 10.1016/j.clnesp.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS We aimed to evaluate body composition (BC) by computed tomography (CT) in hematologic malignancy (HM) patients admitted to the intensive care unit (ICU) for sepsis or septic shock. METHODS We retrospectively assessed BC and its impact on outcome of 186 patients at the 3rd lumbar (L3) and 12th thoracic vertebral levels (T12) using CT-scan performed before ICU admission. RESULTS The median patient age was 58.0 [47; 69] years. Patients displayed adverse clinical characteristics at admission with median [q1; q3] SAPS II and SOFA scores of 52 [40; 66] and 8 [5; 12], respectively. The mortality rate in the ICU was 45.7%. Overall survival rates at 1 month after admission in the pre-existing sarcopenic vs. non pre-existing sarcopenic patients were 47.9% (95% CI [37.6; 61.0]) and 55.0% (95% CI [41.6; 72.8]), p = 0.99), respectively, at the L3 level and 48.4% (95% CI [40.4; 58.0]) vs. 66.7% (95% CI [51.1; 87.0]), p = 0.062), respectively, at the T12 level. CONCLUSIONS Sarcopenia is assessable by CT scan at both the T12 and L3 levels and is highly prevalent in HM patients admitted to the ICU for severe infections. Sarcopenia may contribute to the high mortality rate in the ICU in this population.
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Affiliation(s)
- Antoine Herault
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France; Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Alexandra Zduniak
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Romain Modzelewski
- Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Julie Libraire
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Najate Achamrah
- Department of Nutrition, Charles Nicolle University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Maximilien Grall
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Stéphane Leprêtre
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Hélène Lanic
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | | | - Hervé Tilly
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabienne Tamion
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, France
| | - Vincent Camus
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France.
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Assessment of Functional and Nutritional Status and Skeletal Muscle Mass for the Prognosis of Critically Ill Solid Cancer Patients. Cancers (Basel) 2022; 14:cancers14235870. [PMID: 36497352 PMCID: PMC9737490 DOI: 10.3390/cancers14235870] [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: 10/12/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
Simple and accessible prognostic factors are paramount for solid cancer patients experiencing life-threatening complications. The aim of this study is to appraise the impact of functional and nutritional status and skeletal muscle mass in this population. We conducted a retrospective (2007−2020) single-center study by enrolling adult patients with solid cancers requiring unplanned ICU admission. Performance status, body weight, and albumin level were collected at ICU admission and over six months. Skeletal muscle mass was assessed at ICU admission by measuring muscle areas normalized by height (SMI). Four-hundred and sixty-two patients were analyzed, mainly with gastro-intestinal (34.8%) and lung (29.9%) neoplasms. Moreover, 92.8% of men and 67.3% of women were deemed cachectic. In the multivariate analysis, performance status at ICU admission (CSH 1.74 [1.27−2.39], p < 0.001) and the six month increase in albumin level (CSH 0.38 [0.16−0.87], p = 0.02) were independent predictors of ICU mortality. In the subgroup of mechanically ventilated patients, the psoas SMI was independently associated with ICU mortality (CSH 0.82 [0.67−0.98], p = 0.04). Among the 368 ICU-survivors, the performance status at ICU admission (CSH 1.34 [1.14−1.59], p < 0.001) and the six-month weight loss (CSH 1.33 [1.17−2.99], p = 0.01) were associated with a one-year mortality rate. Most cancer patients displayed cachexia at ICU admission. Time courses of nutritional parameters may aid the prediction of short- and long-term outcomes.
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