Association of diaphragm thickness and density measured on chest CT with disease severity in COVID-19 patients

Parlak, Selçuk; Beşler, Muhammed Said; Gökhan, Muhammet Batuhan

doi:10.1016/j.ajem.2022.08.029

Cited by 7 publications

(18 citation statements)

References 27 publications

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“…In the literature, there are positive and negative views concerning the use of these parameters in predicting the prognosis of COVID-19. 13 , 18 – 21 Therefore, we considered that it was important to evaluate musculoskeletal parameters in the same population with largely similar etiological risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…In a study conducted with CT, a thin diaphragm was found to be associated with mortality and an independent predictor for serious disease, while another study showed a relationship between a thin diaphragm and long hospital stay. 21 , 38 In a study in which diaphragm thickness was reported to be lower in the mechanical ventilation and mortality groups, the cut-off values were determined as 3.35 and 3.275 mm, respectively. 39 Parlak et al 21 found the cut-off value of diaphragm thickness as 3.67 mm for ICU admission and 3.47 mm for mortality.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 38 In a study in which diaphragm thickness was reported to be lower in the mechanical ventilation and mortality groups, the cut-off values were determined as 3.35 and 3.275 mm, respectively. 39 Parlak et al 21 found the cut-off value of diaphragm thickness as 3.67 mm for ICU admission and 3.47 mm for mortality. Many studies conducted with US also indicated that DD was lower in the severe patient group, 40 while the diaphragm was thinner in patients that developed complications, 9 and mechanical ventilation and mortality could be predicted by a diaphragm examination performed within 12 h of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients

Emekli

Can

2023

J Intensive Care Med

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Objective We aimed to analyze the prognostic value of muscle volume (MV), bone mineral density (BMD), and diaphragm diameter (DD) in COVID-19. Method The study included 498 patients admitted to the intensive care unit (ICU) with a positive polymerase chain reaction test for COVID-19 from March 11, 2020, through August 31, 2022. The patients’ laboratory and demographic data of the patients at the time of ICU admission were recorded. MV, DD, and BMD measurements were performed using computed tomography examinations. Muscle index (MI) was calculated as MV/height2. Quartiles were determined for all 4 measurements. Patients in the lowest quartile were recorded as having low MV, MI, DD, and BMD values. The parameters were evaluated for the whole group and compared according to gender and mortality. The multiple regression analysis was performed for the prediction of mortality. Results In the mortality group, the male and female patients had significantly statistically lower values in MV ( P < .001 and P = .002, respectively), MI ( P < .001 and P = .005, respectively), DD ( P < .001 and P < .001, respectively), and BMD ( P = .002 and P < .001, respectively). In the multiple regression analysis, low MI (OR: 2.03, 95% CI: 1.14-3.61, P = .016) and DD (OR: 10.47, 95% CI: 5.59-19.59, P < .001) values remained significant for the prediction of mortality. Conclusion BMD is a risk factor for mortality in patients with severe COVID-19, but cannot be used as an independent predictor. However, MI and DD can be used as independent predictors of mortality even in severe cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients

Emekli

Can

2023

J Intensive Care Med

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“…Recent studies have highlighted the importance of the respiratory muscles status in COVID-19 patients, not only as a predictor for the severity of the infection symptoms, but also as a target for interventions ( Severin et al, 2022 ). Several studies explore diaphragmatic thickness in COVID-19 patients, finding that the decrease in thickness is closely related to disease-mediated changes and prognosis, generally with computed tomography ( Parlak, Beşler & Gökhan, 2022 ; You et al, 2022 ). USI assessment has the main advantage of accessibility, allowing clinicians to monitor structural changes and relate them to functional changes in a rather unexpensive and safe procedure ( Ureyen Ozdemir et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a respiratory rehabilitation program including an inspiration training device versus traditional respiratory rehabilitation: a randomized controlled trial

Sánchez-Milá,

Abuín-Porras,

Romero-Morales

et al. 2023

PeerJ

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Background In the context of COVID-19, respiratory training is vital for the care and recuperation of individuals. Both exercise-based and instrumental respiratory training have been employed as interventions to enhance respiratory function, providing relief from symptoms in those impacted by the virus. The aim of this study was to evaluate the efficacy of two different respiratory rehabilitation programs. Methods A total of 200 participants affected with COVID-19 respiratory sequels were recruited, with a block randomization regarding sex to ensure equal and appropriate applicability of the results. An experimental controlled and randomized study was conducted, with participants engaging in a 31 days respiratory rehabilitation program, (a) experimental group, inspiratory training device combined with aerobic exercise and (b) traditional respiratory exercises combined with aerobic exercise. Results Both groups improved in cardiorespiratory parameters, with a decrease in systolic and diastolic pressure, dyspnea and lower limbs fatigue, and increased oxygen saturation, 6 min walking distance, diaphragmatic thickness, forced vital capacity, forced expiratory volume during the first second, peak expiratory flow rate, forced inspiratory vital capacity and maximal inspiratory pressure. Comparison between groups showed statistically significant differences in all variables except for oxygen saturation, 6 min walking distance and diaphragmatic thickness. The results of this study support the use of specific inspiration training devices for respiratory rehabilitation in COVID-19 sequels.

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“…As such, thorax computed tomography (CT) is one of the most practical and rapid evaluation approaches that can aid critically ill COVID-19 patients, and it is widely accepted for diagnosing the severity and prognosis of COVID-19 [8,9]. Although CT is regarded as the gold standard for determining total skeletal muscle quantity [10], nowadays it is viewed as a possible means to predict disease severity and patient prognosis [11,12]. Quantitative tissue measures can be acquired using CT in a very reproducible manner, and some data derived from CT have been shown to strongly correlate with clinical outcomes [11,12].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Diaphragm Thickness Decrease in Critically Ill COVID-19 Patients: Could Computed Tomography Be of Aid Regarding Diaphragm Muscle Mass?

Branea,

Copotoiu,

Becica

et al. 2023

Cureus

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Introduction:The diaphragm has a significant clinical value on respiratory performance. There is little literature on the use of thorax computed tomography for the purpose of identifying alterations in diaphragm thickness in critically ill patients diagnosed with COVID-19. The present study aims to investigate dynamic changes in muscle thickness and its association with clinical outcomes.Methods: A single-center retrospective observational study was conducted in a tertiary intensive care unit (ICU). The study comprised adult patients with severe COVID-19 who were admitted to the ICU and underwent two thorax CT scans. We measured diaphragmatic thickness at the level of the celiac truncus.Results: The average reduction in thickness of the dynamic diaphragm was found to be -0.58 mm for the right diaphragm and -0.54 mm for the left diaphragm. The diaphragm thickness exhibited a substantial decrease on both the right and left sides in both CT scans (p=0.02). A negative correlation coefficient was observed for both the right and left diaphragm. The criterion indicating a poor prognosis for the right diaphragm was a value greater than -0.175, whereas it was more significant for the left diaphragm than -0.435. The cut-off values indicated a high risk of prolonged mechanical ventilation and an increased risk of ICU mortality.Conclusion: CT diaphragm evaluation in mechanically ventilated COVID-19 patients has the possibility of becoming a reliable tool for predicting muscle modifications.

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Association of diaphragm thickness and density measured on chest CT with disease severity in COVID-19 patients

Cited by 7 publications

References 27 publications

Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients

Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients

Effectiveness of a respiratory rehabilitation program including an inspiration training device versus traditional respiratory rehabilitation: a randomized controlled trial

Assessment of the Diaphragm Thickness Decrease in Critically Ill COVID-19 Patients: Could Computed Tomography Be of Aid Regarding Diaphragm Muscle Mass?

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