Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients

Annals of Intensive Care

Research

Christian Pille¹  Zvonimir A. Rako²  Laura K. Segger³  Dominik Geisel³  Uli Fehrenbach³  Timo A. Auer⁴  Tobias Penzkofer⁴  Nick L. Beetz⁴  Johannes Kolck⁵ 

[1] Department of Anesthesiology and Intensive Care Medicine

[2]  CCM

[3]  CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany;Department of Pneumology and Intensive Care, Universities of Giessen and Giessen Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Berlin, Germany;Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany;Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany;Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany;Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany;Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany;Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany;

关键词: Critical care;    COVID-19;    Muscle wasting;    Artificial intelligence;    Body composition analysis;    Computed tomography;   

DOI  :  10.1186/s13613-023-01162-5

 received in 2023-04-05, accepted in 2023-07-03,  发布年份 2023

来源: Springer

【 摘 要 】

ObjectivesSARS-CoV-2 virus infection can lead to acute respiratory distress syndrome (ARDS), which can be complicated by severe muscle wasting. Until now, data on muscle loss of critically ill COVID-19 patients are limited, while computed tomography (CT) scans for clinical follow-up are available. We sought to investigate the parameters of muscle wasting in these patients by being the first to test the clinical application of body composition analysis (BCA) as an intermittent monitoring tool.MaterialsBCA was conducted on 54 patients, with a minimum of three measurements taken during hospitalization, totaling 239 assessments. Changes in psoas- (PMA) and total abdominal muscle area (TAMA) were assessed by linear mixed model analysis. PMA was calculated as relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan. Cox regression was applied to analyze associations with survival. Receiver operating characteristic (ROC) analysis and Youden index were used to define a decay cut-off.ResultsIntermittent BCA revealed significantly higher long-term PMA loss rates of 2.62% (vs. 1.16%, p < 0.001) and maximum muscle decay of 5.48% (vs. 3.66%, p = 0.039) per day in non-survivors. The first available decay rate did not significantly differ between survival groups but showed significant associations with survival in Cox regression (p = 0.011). In ROC analysis, PMA loss averaged over the stay had the greatest discriminatory power (AUC = 0.777) for survival. A long-term PMA decline per day of 1.84% was defined as a threshold; muscle loss beyond this cut-off proved to be a significant BCA-derived predictor of mortality.ConclusionMuscle wasting in critically ill COVID-19 patients is severe and correlates with survival. Intermittent BCA derived from clinically indicated CT scans proved to be a valuable monitoring tool, which allows identification of individuals at risk for adverse outcomes and has great potential to support critical care decision-making.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

41116_2023_38_Article_IEq308.gif

41116_2023_38_Article_IEq294.gif

41523_2023_562_Article_IEq4.gif