ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study

Critical Care

Paul J. Feustel¹  John Fantauzzi²  Camille L. Dumas²  Ali Naqvi³  Hau C. Chieng³  Marc A. Judson³  Ria Itty³  Ariel Jaitovich⁴  Malik M. H. S. Khan⁵  Jesse B. Hall⁶ 

[1] Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA;Department of Radiology, Albany Medical College, Albany, NY, USA;Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA;Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA;Department of Molecular and Cellular Physiology, Albany Medical College, 47 New Scotland Av, Albany, NY, USA;Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA;Present Address: Division of Pulmonary and Critical Care Medicine Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI, USA;Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA;

关键词: Skeletal muscle;    Adipose tissue;    Bone density;    Critical illness;    Mortality;   

DOI  :  10.1186/s13054-020-03276-9

来源: Springer

【 摘 要 】

BackgroundReduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density.MethodsSingle-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders.ResultsLarger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity.ConclusionIn our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures.

【 授权许可】

CC BY