Michael T Paris1, Marina Mourtzakis1, Andrew Day2, Roger Leung2, Snehal Watharkar1, Rosemary Kozar3, Carrie Earthman4, Adam Kuchnia4, Rupinder Dhaliwal2, Lesley Moisey1, Charlene Compher5,6, Niels Martin7, Michelle Nicolo7, Tom White8, Hannah Roosevelt9, Sarah Peterson9, Daren K Heyland2. 1. 1 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. 2. 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada. 3. 3 Surgery, University of Texas, Houston, Texas, USA. 4. 4 Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA. 5. 5 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 6. 6 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 7. 7 Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 8. 8 Surgery, Intermountain Medical Center, Murray, Utah, USA. 9. 9 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
Abstract
BACKGROUND: In critically ill patients, muscle atrophy is associated with long-term disability and mortality. Bedside ultrasound may quantify muscle mass, but it has not been validated in the intensive care unit (ICU). Here, we compared ultrasound-based quadriceps muscle layer thickness (QMLT) with precise quantifications of computed tomography (CT)-based muscle cross-sectional area (CSA). METHODS: Patients ≥18 years old with abdominal CT scans performed for clinical reasons were recruited from 9 ICUs for an ultrasound assessment of the quadriceps. CT scans of the third lumbar vertebra, performed <24 hours before or <72 hours after ICU admission, were analyzed for CSA. Low muscularity was defined as 170 cm2 for men and 110 cm2 for women. The ultrasound probe was maximally compressed against the skin and QMLT was measured on 2 sites of each quadriceps <72 hours of the CT scan. RESULTS: Mean CT-derived muscle CSA was 109 ± 25 cm2 for women and 168 ± 37 cm2 for men, where 58% of patients exhibited low muscularity; only 2.7% patients were underweight according to body mass index. QMLT was positively correlated with CT CSA ( r = 0.45, P < .001). Based on logistic regression to predict low muscularity, QMLT independently generated a concordance index ( c) of 0.67 ( P < .002), which increased to 0.77 ( P < .001) when age, sex, body mass index, Charlson Comorbidity Index, and admission type (surgical vs medical) were added. CONCLUSIONS: Our results suggest that QMLT alone with our current protocol may not accurately identify patients with low muscle mass.
BACKGROUND: In critically illpatients, muscle atrophy is associated with long-term disability and mortality. Bedside ultrasound may quantify muscle mass, but it has not been validated in the intensive care unit (ICU). Here, we compared ultrasound-based quadriceps muscle layer thickness (QMLT) with precise quantifications of computed tomography (CT)-based muscle cross-sectional area (CSA). METHODS:Patients ≥18 years old with abdominal CT scans performed for clinical reasons were recruited from 9 ICUs for an ultrasound assessment of the quadriceps. CT scans of the third lumbar vertebra, performed <24 hours before or <72 hours after ICU admission, were analyzed for CSA. Low muscularity was defined as 170 cm2 for men and 110 cm2 for women. The ultrasound probe was maximally compressed against the skin and QMLT was measured on 2 sites of each quadriceps <72 hours of the CT scan. RESULTS: Mean CT-derived muscle CSA was 109 ± 25 cm2 for women and 168 ± 37 cm2 for men, where 58% of patients exhibited low muscularity; only 2.7% patients were underweight according to body mass index. QMLT was positively correlated with CT CSA ( r = 0.45, P < .001). Based on logistic regression to predict low muscularity, QMLT independently generated a concordance index ( c) of 0.67 ( P < .002), which increased to 0.77 ( P < .001) when age, sex, body mass index, Charlson Comorbidity Index, and admission type (surgical vs medical) were added. CONCLUSIONS: Our results suggest that QMLT alone with our current protocol may not accurately identify patients with low muscle mass.
Authors: Michael T Paris; Helena F Furberg; Stacey Petruzella; Oguz Akin; Andreas M Hötker; Marina Mourtzakis Journal: JPEN J Parenter Enteral Nutr Date: 2018-01-19 Impact factor: 4.016
Authors: Diogo Oliveira Toledo; Débora Carneiro de Lima E Silva; Dyaiane Marques Dos Santos; Branca Jardini de Freitas; Rogério Dib; Ricardo Luiz Cordioli; Evandro José de Almeida Figueiredo; Silvia Maria Fraga Piovacari; João Manoel Silva Journal: Rev Bras Ter Intensiva Date: 2017 Oct-Dec
Authors: Kate Fetterplace; Adam M Deane; Audrey Tierney; Lisa Beach; Laura D Knight; Thomas Rechnitzer; Adrienne Forsyth; Marina Mourtzakis; Jeffrey Presneill; Christopher MacIsaac Journal: Pilot Feasibility Stud Date: 2018-02-20