Morphometric parameters of muscle and bone in critically ill patients
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01736-4
Morphometric parameters of muscle and bone in critically ill patients Post hoc analysis of the VITdAL-ICU trial Oliver Malle · Dietmar Maurer · Doris Wagner · Christian Schnedl · Steven Amrein · Thomas Pieber · Astrid Fahrleitner-Pammer · Hans Peter Dimai · Karin Amrein Received: 20 May 2020 / Accepted: 12 August 2020 © The Author(s) 2020
Summary Background Sarcopenia, defined as loss of muscle mass, quality and function, is a part of the frailty syndrome. In critical illness, sarcopenia has rarely been evaluated regarding clinical outcomes. Therefore, we evaluated the association of sarcopenia with both hospital length of stay (HLOS) and 6-month mortality in critically ill patients using abdominal computed tomography (CT) scans. Methods In a post hoc analysis from the high dose vitamin D3 vs. placebo in adult vitamin D deficient patients (VITdAL-ICU) trial, we retrospectively reviewed all available abdominal CT scans (18 women, 19 men). We measured and calculated total psoas area (TPA), psoas muscle density (PMD), skeletal muscle index (SMI) and bone mineral density (BMD) and analyzed the relation of these endpoints with HLOS and mortality. Defining sarcopenia we used cut-off values for TPA
as 642.1 mm2/m2 in women and 784 mm2/m2 in men and PMD as 31.1 Hounsfield units (HU) in women and 33.3 HU in men, both measured at the level of L3, as well as for SMI (38.5 cm2/m2 in women and 52.4 cm2/m2 in men). Likely osteoporosis was defined by L1 trabecular attenuation of ≤110 HU. Values for TPA, PMD and SMI could not be obtained in 11 patients and BMD in 1 patient. Results Mean adjusted TPA was lower in women versus men (478 vs. 749 mm2/m2) as well as PMD (34.6 vs. 41.3 HU), SMI (62.36 vs. 76.81 cm2/m2) and BMD (141.1 vs. 157.2 HU). No significant influence on hospital length of stay and on 6-month mortality was found, irrespective of the morphometric parameter used (TPA, PMD, SMI, BMD; p > 0.05). Survivors showed statistically nonsignificantly better values than nonsurvivors: TPA: 652 vs. 530 mm2/m2
Dr.med.univ. O. Malle () · Cand.med. D. Maurer · Univ.-Prof. Dr.med.univ. T. Pieber · Univ. Doz. Dr.med.univ. A. Fahrleitner-Pammer · Univ.-Prof. Dr.med.univ. H. P. Dimai · Assoz. Prof. PD Dr. med.univ. K. Amrein Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria [email protected]
PD Dr.med.univ. D. Wagner Department of Surgery, Medical University of Graz, Graz, Austria [email protected]
Cand.med. D. Maurer [email protected] Univ.-Prof. Dr.med.univ. T. Pieber [email protected]
Dr.med.univ. et scient.med. C. Schnedl Department of Interventional and Diagnostic Radiology, General Hospital of Klagenfurt, Graz, Austria [email protected] Dr.med.univ. S. Amrein Department of Anesthesiology, Elisabethinen Hospital, Graz, Austria [email protected]
Univ. Doz. Dr.med.univ. A. Fahrleitner-Pammer [email protected] Univ.-Prof. Dr.me
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