Daniel Dante Yeh1, Luis Alfonso Ortiz-Reyes2, Sadeq A Quraishi3, Nalin Chokengarmwong2, Laura Avery4, Haytham M A Kaafarani2, Jarone Lee2, Peter Fagenholz2, Yuchiao Chang5, Marc DeMoya2, George Velmahos2. 1. Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, United States. Electronic address: dxy154@miami.edu. 2. Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, United States. 3. Massachusetts General Hospital, Department of Anesthesia, United States. 4. Massachusetts General Hospital, Department of Radiology, United States. 5. Massachusetts General Hospital, Department of Medicine, United States.
Abstract
PURPOSE: To explore whether psoas cross sectional area (CSA) and density (Hounsfield Units, HU) are associated with nutritional adequacy and clinical outcomes in surgical intensive care unit patients. MATERIALS AND METHODS: Subjects with at least one CT scan within 72h of ICU admission were included. Demographic, nutritional, radiographic, and outcomes data were collected. Psoas muscle CSA and HU were assessed at the L4-L5 intervertebral disk level. Change (Δ) in CSA and HU overall and per day were calculated. RESULTS: 140 patients were included. There was no significant correlation between baseline CSA and HU and clinical outcomes. Patients with at least two CT scans (n=65), had a median decrease in CSA of -15% [IQR: -20%, -8%] and decrease in HU of -2% [IQR: -30%, +24%]. Patients with the greatest daily %HU decline received significantly fewer calories/kg and proteins/kg and accumulated greater protein deficits at day 7 and overall. Patients with daily %HU increase had the shortest ICU and hospital LOS and more ventilator-free days in univariate and multivariable analyses. CONCLUSIONS: In this exploratory study, early nutritional deficits were correlated with muscle quality deterioration. Inpatient gain in psoas density, compared to maintenance or loss, is associated with shorter hospital stay.
PURPOSE: To explore whether psoas cross sectional area (CSA) and density (Hounsfield Units, HU) are associated with nutritional adequacy and clinical outcomes in surgical intensive care unit patients. MATERIALS AND METHODS: Subjects with at least one CT scan within 72h of ICU admission were included. Demographic, nutritional, radiographic, and outcomes data were collected. Psoas muscle CSA and HU were assessed at the L4-L5 intervertebral disk level. Change (Δ) in CSA and HU overall and per day were calculated. RESULTS: 140 patients were included. There was no significant correlation between baseline CSA and HU and clinical outcomes. Patients with at least two CT scans (n=65), had a median decrease in CSA of -15% [IQR: -20%, -8%] and decrease in HU of -2% [IQR: -30%, +24%]. Patients with the greatest daily %HU decline received significantly fewer calories/kg and proteins/kg and accumulated greater protein deficits at day 7 and overall. Patients with daily %HU increase had the shortest ICU and hospital LOS and more ventilator-free days in univariate and multivariable analyses. CONCLUSIONS: In this exploratory study, early nutritional deficits were correlated with muscle quality deterioration. Inpatient gain in psoas density, compared to maintenance or loss, is associated with shorter hospital stay.
Authors: Kyle H Cichos; Khalid H Mahmoud; Clay A Spitler; Ahmed M Kamel Abdel Aal; Sarah Osman; Gerald McGwin; Elie S Ghanem Journal: Clin Orthop Relat Res Date: 2020-08 Impact factor: 4.755
Authors: Alberto Romano; Silvia Triarico; Emanuele Rinninella; Luigi Natale; Maria Gabriella Brizi; Marco Cintoni; Pauline Raoul; Palma Maurizi; Giorgio Attinà; Stefano Mastrangelo; Antonio Gasbarrini; Maria Cristina Mele; Antonio Ruggiero Journal: Nutrients Date: 2022-01-17 Impact factor: 5.717