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Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

INTRODUCTION: Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. METHODS: This retrospective analysis in 240 mechanically ventilated critically ill p...

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Autores principales: Weijs, Peter JM, Looijaard, Wilhelmus GPM, Dekker, Ingeborg M, Stapel, Sandra N, Girbes, Armand R, Straaten, Heleen M Oudemans-van, Beishuizen, Albertus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028783/
https://www.ncbi.nlm.nih.gov/pubmed/24410863
http://dx.doi.org/10.1186/cc13189
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author Weijs, Peter JM
Looijaard, Wilhelmus GPM
Dekker, Ingeborg M
Stapel, Sandra N
Girbes, Armand R
Straaten, Heleen M Oudemans-van
Beishuizen, Albertus
author_facet Weijs, Peter JM
Looijaard, Wilhelmus GPM
Dekker, Ingeborg M
Stapel, Sandra N
Girbes, Armand R
Straaten, Heleen M Oudemans-van
Beishuizen, Albertus
author_sort Weijs, Peter JM
collection PubMed
description INTRODUCTION: Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. METHODS: This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm(2) for females and 170 cm(2) for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. RESULTS: This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m(2). Muscle area for females was significantly lower than that for males (102 ± 23 cm(2) versus 158 ± 33 cm(2); P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex. CONCLUSIONS: Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for.
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spelling pubmed-40287832014-05-22 Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients Weijs, Peter JM Looijaard, Wilhelmus GPM Dekker, Ingeborg M Stapel, Sandra N Girbes, Armand R Straaten, Heleen M Oudemans-van Beishuizen, Albertus Crit Care Research INTRODUCTION: Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. METHODS: This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm(2) for females and 170 cm(2) for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. RESULTS: This study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m(2). Muscle area for females was significantly lower than that for males (102 ± 23 cm(2) versus 158 ± 33 cm(2); P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex. CONCLUSIONS: Low skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for. BioMed Central 2014 2014-01-13 /pmc/articles/PMC4028783/ /pubmed/24410863 http://dx.doi.org/10.1186/cc13189 Text en Copyright © 2014 Weijs et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Weijs, Peter JM
Looijaard, Wilhelmus GPM
Dekker, Ingeborg M
Stapel, Sandra N
Girbes, Armand R
Straaten, Heleen M Oudemans-van
Beishuizen, Albertus
Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title_full Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title_fullStr Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title_full_unstemmed Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title_short Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
title_sort low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028783/
https://www.ncbi.nlm.nih.gov/pubmed/24410863
http://dx.doi.org/10.1186/cc13189
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