Early nutritional inadequacy is associated with psoas muscle deterioration and worse clinical outcomes in critically ill surgical patients
Early nutritional inadequacy is associated with psoas muscle deterioration and worse clinical outcomes in critically ill surgical patients
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DOI：
10.1016/j.jcrc.2017.12.027
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发表时间：
2018-06-01
影响因子：
3.7
通讯作者：
Velmahos, George
中科院分区：
文献类型：
--
作者：
Yeh, Daniel Dante;Ortiz-Reyes, Luis Alfonso;Velmahos, George
目的：探讨腰大肌横截面积（CSA）和密度（Hounsfield单位，HU）是否与外科重症监护室patients.Materials和方法的营养充足性和临床结局：至少有一个CT扫描在72小时内ICU入院的主题。收集人口统计学、营养学、影像学和结局数据。在L4-L5椎间盘水平评估腰大肌CSA和HU。结果：共纳入140例患者，其中140例患者的CSA和HU在总体和每日的变化（Delta）。基线CSA和HU与临床结局之间没有显着相关性。至少接受过两次CT扫描的患者（n = 65）的CSA中位数降低了-15% [IQR：-20%，-8%]，HU降低了-2%[IQR：-30%，+24%]。每日%HU下降最大的患者接受的卡路里/kg和蛋白质/kg显著减少，并且在第7天和总体上累积了更大的蛋白质缺乏。每日%HU增加的患者有最短的ICU和医院LOS和更多的无呼吸机天在单变量和多变量analysis.Conclusions：在这项探索性研究中，早期营养不足与肌肉质量恶化。住院患者腰肌密度增加，与维持或损失相比，与较短的住院时间相关。(C)2018爱思唯尔公司All rights reserved.
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 72 h 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 (Delta) 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%j 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. (C) 2018 Elsevier Inc. All rights reserved.