Alice Sabatino1, Giuseppe Regolisti1,2, Francesca di Mario1,2, Andrea Ciuni3, Anselmo Palumbo3, Francesco Peyronel1,2, Umberto Maggiore1,2, Enrico Fiaccadori4,5. 1. UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy. 2. Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. 3. Radiologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy. 4. UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy. enrico.fiaccadori@unipr.it. 5. Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. enrico.fiaccadori@unipr.it.
Abstract
BACKGROUND: Accelerated muscle wasting still represents a major issue in critically ill patients. However, a key problem in the intensive care unit is the lack of adequate tools for bedside evaluation of muscle mass. Moreover, when acute kidney injury (AKI) coexists, fluid overload and/or rapid fluid shifts due to renal replacement therapies that frequently occur and may interfere with muscle mass assessment. The purpose of this study is to validate muscle ultrasound (US) by a gold standard (muscle CT scan) for the assessment of quadriceps muscle thickness in critically ill patients with AKI. METHODS: Quadriceps rectus femoris thickness and quadriceps vastus intermedius thickness of critically ill patients with AKI were blindly assessed at the same leg sites by both US and computed tomography (CT) scan. Using bivariate mixed-model linear regression analysis, we estimated, average difference in thickness between measurement sites, agreement (differential and proportional bias) of US compared to CT, and precision of the two methods, and eventually performed Bland-Altman analysis for repeated measurements on pooled results. RESULTS: We analyzed 233 couples of measurements (30 patients). Average muscle thickness ranged between 1.0 and 1.6, depending on the measurement site. When comparing US to CT, both the observed differential bias (between + 0.04 and + 0.26 cm depending on the muscle site) and the proportional bias (between 82 and 98% of the reference values, depending on the muscle site) were not statistically significant. However, precision analysis showed that US scan tended to be slightly less precise in comparison to CT. Bland-Altman analysis on pooled results showed that the 95% limits of agreement between the US and CT were narrow, ranging from - 0.34 to + 0.36 cm. CONCLUSION: In critically ill patients with AKI, quadriceps muscle thickness assessment based on US is unbiased, although it occurs with a minor loss of precision compared to CT.
BACKGROUND: Accelerated muscle wasting still represents a major issue in critically illpatients. However, a key problem in the intensive care unit is the lack of adequate tools for bedside evaluation of muscle mass. Moreover, when acute kidney injury (AKI) coexists, fluid overload and/or rapid fluid shifts due to renal replacement therapies that frequently occur and may interfere with muscle mass assessment. The purpose of this study is to validate muscle ultrasound (US) by a gold standard (muscle CT scan) for the assessment of quadriceps muscle thickness in critically illpatients with AKI. METHODS:Quadriceps rectus femoris thickness and quadriceps vastus intermedius thickness of critically illpatients with AKI were blindly assessed at the same leg sites by both US and computed tomography (CT) scan. Using bivariate mixed-model linear regression analysis, we estimated, average difference in thickness between measurement sites, agreement (differential and proportional bias) of US compared to CT, and precision of the two methods, and eventually performed Bland-Altman analysis for repeated measurements on pooled results. RESULTS: We analyzed 233 couples of measurements (30 patients). Average muscle thickness ranged between 1.0 and 1.6, depending on the measurement site. When comparing US to CT, both the observed differential bias (between + 0.04 and + 0.26 cm depending on the muscle site) and the proportional bias (between 82 and 98% of the reference values, depending on the muscle site) were not statistically significant. However, precision analysis showed that US scan tended to be slightly less precise in comparison to CT. Bland-Altman analysis on pooled results showed that the 95% limits of agreement between the US and CT were narrow, ranging from - 0.34 to + 0.36 cm. CONCLUSION: In critically illpatients with AKI, quadriceps muscle thickness assessment based on US is unbiased, although it occurs with a minor loss of precision compared to CT.
Authors: F Landi; M Camprubi-Robles; D E Bear; T Cederholm; V Malafarina; A A Welch; A J Cruz-Jentoft Journal: Clin Nutr Date: 2018-11-30 Impact factor: 7.324
Authors: Alice Sabatino; Umberto Maggiore; Giuseppe Regolisti; Giovanni Maria Rossi; Francesca Di Mario; Micaela Gentile; Maria Teresa Farina; Enrico Fiaccadori Journal: Front Nutr Date: 2021-04-15