Computed tomography measured psoas density predicts outcomes in trauma

Abstract

Background Age-related loss of muscle mass and function (sarcopenia) is linked to poor outcomes after surgery and trauma. Here we evaluate CT measured psoas muscle density and area using quick and simple tools available to the beside clinician. We hypothesize these measures will predict poor outcomes after blunt traumatic injury. Methods We conducted a retrospective cohort study of patients ages ≥ 45 years in the Ohio State University Trauma Registry in 2008 that received a CT abdomen/pelvis with intravenous contrast. Psoas Index (PI) and Hounsfield Unit average calculation (HUAC) were measured at the L3 level. 90-day mortality, complication, length of stay ≥ 7 days, dependent discharge were compared to PI and HUAC. Results 151 patients met inclusion criteria. Patients were stratified into interquartile ranges based either on PI or HUAC values. After adjustment with sex-specific cutoffs, the lowest interquartile range of PI was associated with 90-day mortality (RR 5.95, p < 0.008) but did not reach significance in other outcomes. The lowest interquartile range of HUAC was associated with 90-day mortality (RR 5.95, p < 0.008) length of stay ≥ 7 days (RR 1.63, p = 0.048), complication risk (RR 2.30, p = 0.002), and dependent discharge 2.14, p = 0.015). Conclusion Psoas muscle density is a significant predictor of poor outcomes after traumatic injury. This objective, quick, and readily available measure of sarcopenia can identify patients requiring aggressive nutritional and physical therapy to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.

Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection

“…Calculation of psoas density may be a more accurate method of determining sarcopenia than psoas area, as variable fat content of the skeletal muscle may increase cross-sectional area confounding the measurement of lean muscle area and does not require standardisation for height and weight [ 8 ]. Psoas density better predicted poor outcomes compared to cross-sectional area in a cohort of trauma patients [ 9 ], a cohort having pancreatectomy [ 10 ], a cohort of patients having cardiac surgery [ 11 ] and patients having an emergency laparotomy [ 12 ]. However, most studies used software separate to the main imaging viewing and reporting software.…”

Preoperatively Identified Sarcopenia Leads to Increased Postoperative Complications, Hospital and ICU Length of Stay in Autologous Microsurgical Breast Reconstruction

“…3,4 Recently, this condition has been found to be associated with increased adverse perioperative outcomes in the general, thoracic, and transplant surgery literature. [5][6][7][8][9][10][11][12] New methods of identifying sarcopenia through analysis of cross-sectional computed tomography (CT) scans by commercially and publicly available software has been developed. 13 The incidence and significance of sarcopenia has not been evaluated in patients undergoing breast reconstruction with autologous free tissue transfer.…”

Psoas Muscle Density in Combination with Model for End-Stage Liver Disease Score Can Improve Survival Predictability in Transjugular Intrahepatic Portosystemic Shunts

“…It has therefore been proposed that direct CT measurement of muscle density more accurately represents muscle quality than cross-sectional muscle area (18). In fact, several groups (15,(19)(20)(21)(22) have used psoas muscle density (PD), measured in Hounsfield units, as a means to assess sarcopenia.…”