Neil J Greening1,2, Theresa C Harvey-Dunstan1,2, Emma J Chaplin1, Emma E Vincent1, Mike D Morgan1, Sally J Singh1,2,3, Michael C Steiner1,3. 1. 1 Centre for Exercise and Rehabilitation Science, Institute of Lung Health, Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Glenfield Hospital, Leicester, United Kingdom. 2. 2 Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, United Kingdom; and. 3. 3 School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
Abstract
RATIONALE: Hospitalization represents a major event for the patient with chronic respiratory disease. There is a high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction. OBJECTIVES: We assessed the risk of hospital readmission at 1 year, including measures of lower limb muscle as part of a larger clinical trial. METHODS: Patients hospitalized with an exacerbation of chronic respiratory disease underwent measures of muscle function including quadriceps ultrasound. Independent factors influencing time to hospital readmission or death were identified. Patients were classified into four quartiles based on quadriceps size and compared. MEASUREMENTS AND MAIN RESULTS: One hundred and ninety-one patients (mean age, 71.6 [SD, 9.1] yr) were recruited. One hundred and thirty (68%) were either readmitted or died. Factors associated with readmission or death were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08; P = 0.015), Medical Research Council (MRC) dyspnea grade (OR, 4.57; 95% CI, 2.62-7.95; P < 0.001), home oxygen use (OR, 12.4; 95% CI, 4.53-33.77; P < 0.001), quadriceps (rectus femoris) cross-sectional area (Qcsa) (OR, 0.34; 95% CI, 0.17-0.65; P = 0.001), and hospitalization in the previous year (OR, 4.82; 95% CI, 2.42-9.58; P < 0.001). In the multivariate analyses, home oxygen use (OR, 4.80; 95% CI, 1.68-13.69; P = 0.003), MRC dyspnea grade (OR, 2.57; 95% CI, 1.44-4.59; P = 0.001), Qcsa (OR, 0.46; 95% CI, 0.22-0.95; P = 0.035), and previous hospitalization (OR, 3.04; 95% CI, 1.47-6.29; P = 0.003) were independently associated with readmission or death. Patients with the smallest muscle spent more days in hospital than those with largest muscle (28.1 [SD, 33.9] vs. 12.2 [SD, 23.5] d; P = 0.007). CONCLUSIONS: Smaller quadriceps muscle size, as measured by ultrasound in the acute care setting, is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification.
RATIONALE: Hospitalization represents a major event for the patient with chronic respiratory disease. There is a high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction. OBJECTIVES: We assessed the risk of hospital readmission at 1 year, including measures of lower limb muscle as part of a larger clinical trial. METHODS:Patients hospitalized with an exacerbation of chronic respiratory disease underwent measures of muscle function including quadriceps ultrasound. Independent factors influencing time to hospital readmission or death were identified. Patients were classified into four quartiles based on quadriceps size and compared. MEASUREMENTS AND MAIN RESULTS: One hundred and ninety-one patients (mean age, 71.6 [SD, 9.1] yr) were recruited. One hundred and thirty (68%) were either readmitted or died. Factors associated with readmission or death were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08; P = 0.015), Medical Research Council (MRC) dyspnea grade (OR, 4.57; 95% CI, 2.62-7.95; P < 0.001), home oxygen use (OR, 12.4; 95% CI, 4.53-33.77; P < 0.001), quadriceps (rectus femoris) cross-sectional area (Qcsa) (OR, 0.34; 95% CI, 0.17-0.65; P = 0.001), and hospitalization in the previous year (OR, 4.82; 95% CI, 2.42-9.58; P < 0.001). In the multivariate analyses, home oxygen use (OR, 4.80; 95% CI, 1.68-13.69; P = 0.003), MRC dyspnea grade (OR, 2.57; 95% CI, 1.44-4.59; P = 0.001), Qcsa (OR, 0.46; 95% CI, 0.22-0.95; P = 0.035), and previous hospitalization (OR, 3.04; 95% CI, 1.47-6.29; P = 0.003) were independently associated with readmission or death. Patients with the smallest muscle spent more days in hospital than those with largest muscle (28.1 [SD, 33.9] vs. 12.2 [SD, 23.5] d; P = 0.007). CONCLUSIONS: Smaller quadriceps muscle size, as measured by ultrasound in the acute care setting, is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification.
Authors: T L Griffiths; M L Burr; I A Campbell; V Lewis-Jenkins; J Mullins; K Shiels; P J Turner-Lawlor; N Payne; R G Newcombe; A A Ionescu; J Thomas; J Tunbridge; A A Lonescu Journal: Lancet Date: 2000-01-29 Impact factor: 79.321
Authors: Emma L Watson; Neil J Greening; João L Viana; Jaspreet Aulakh; Danielle H Bodicoat; Jonathan Barratt; John Feehally; Alice C Smith Journal: Am J Kidney Dis Date: 2014-12-18 Impact factor: 8.860
Authors: Anne E Holland; Martijn A Spruit; Thierry Troosters; Milo A Puhan; Véronique Pepin; Didier Saey; Meredith C McCormack; Brian W Carlin; Frank C Sciurba; Fabio Pitta; Jack Wanger; Neil MacIntyre; David A Kaminsky; Bruce H Culver; Susan M Revill; Nidia A Hernandes; Vasileios Andrianopoulos; Carlos Augusto Camillo; Katy E Mitchell; Annemarie L Lee; Catherine J Hill; Sally J Singh Journal: Eur Respir J Date: 2014-10-30 Impact factor: 16.671
Authors: M A Spruit; R Gosselink; T Troosters; A Kasran; G Gayan-Ramirez; P Bogaerts; R Bouillon; M Decramer Journal: Thorax Date: 2003-09 Impact factor: 9.139
Authors: Samantha S C Kon; Jane L Canavan; Claire M Nolan; Amy L Clark; Sarah E Jones; Paul Cullinan; Michael I Polkey; William D-C Man Journal: Eur Respir J Date: 2013-10-31 Impact factor: 16.671
Authors: Neil J Greening; Johanna E A Williams; Syed F Hussain; Theresa C Harvey-Dunstan; M John Bankart; Emma J Chaplin; Emma E Vincent; Rudo Chimera; Mike D Morgan; Sally J Singh; Michael C Steiner Journal: BMJ Date: 2014-07-08
Authors: Sarah E Jones; Ruth E Barker; Claire M Nolan; Suhani Patel; Matthew Maddocks; William D C Man Journal: J Thorac Dis Date: 2018-05 Impact factor: 2.895
Authors: Brandi A Bottiger; Alina Nicoara; Laurie D Snyder; Paul E Wischmeyer; Jacob N Schroder; Chetan B Patel; Mani A Daneshmand; Robert N Sladen; Kamrouz Ghadimi Journal: J Cardiothorac Vasc Anesth Date: 2018-08-09 Impact factor: 2.628
Authors: Michael I Polkey; Jens Praestgaard; Amy Berwick; Frits M E Franssen; Dave Singh; Michael C Steiner; Richard Casaburi; Hanns-Christian Tillmann; Estelle Lach-Trifilieff; Ronenn Roubenoff; Daniel S Rooks Journal: Am J Respir Crit Care Med Date: 2019-02-01 Impact factor: 21.405
Authors: Raolat M Abdulai; Tina Jellesmark Jensen; Naimish R Patel; Michael I Polkey; Paul Jansson; Bartolomé R Celli; Stephen I Rennard Journal: Am J Respir Crit Care Med Date: 2018-02-15 Impact factor: 21.405
Authors: Valentin Prieto-Centurion; Nina Bracken; Lourdes Norwick; Farhan Zaidi; Amelia A Mutso; Victoria Morken; David B Coultas; Cynthia S Rand; David X Marquez; Jerry A Krishnan Journal: Chronic Obstr Pulm Dis Date: 2016