Relationship Between Skeletal Muscle Area and Density and Clinical Outcome in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation

Bear, Danielle E.; MacGowan, Liisa; Elstad, Maria; Puthucheary, Zudin; Connolly, Bronwen; Wright, Rebeka; Hart, Nicholas; Harridge, Stephen; Whelan, Kevin; Barrett, Nicholas; Camporota, Luigi

doi:10.1097/ccm.0000000000004827

Cited by 17 publications

(18 citation statements)

References 25 publications

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“…Low SMD assessed by CT images is a prognostic factor of poor outcome in critically-ill and non-critically ill patients 32 , 33 , including in COVID-19 cases 16 . In ICU patients, low SMD at ICU admission was independently associated with higher 6-month mortality in non-COVID-19 mechanically-ventilated patients 34 , while preserved SMD at the commencement of venovenous extracorporeal membrane oxygenation was associated with improved ICU survival in non-COVID-19 patients 35 . More recently, low SMD has been associated with higher risk of ICU mortality in COVID-19 patients 36 .…”

Section: Discussionmentioning

confidence: 96%

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19

Padilha

Mendes²,

Lascala³

et al. 2022

Sci Rep

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Inflammatory states and body composition changes are associated with a poor prognosis in many diseases, but their role in coronavirus disease 2019 (COVID-19) is not fully understood. To assess the impact of low skeletal muscle radiodensity (SMD), high neutrophil-to-lymphocyte ratio (NLR) and a composite score based on both variables, on complications, use of ventilatory support, and survival in patients with COVID-19. Medical records of patients hospitalized between May 1, 2020, and July 31, 2020, with a laboratory diagnosis of COVID-19 who underwent computed tomography (CT) were retrospectively reviewed. CT-derived body composition measurements assessed at the first lumbar vertebra level, and laboratory tests performed at diagnosis, were used to calculate SMD and NLR. Prognostic values were estimated via univariate and multivariate logistic regression analyses and the Kaplan–Meier curve. The study was approved by the local Institutional Review Board (CAAE 36276620.2.0000.5404). A total of 200 patients were included. Among the patients assessed, median age was 59 years, 58% were men and 45% required ICU care. A total of 45 (22.5%) patients died. Multivariate logistic analysis demonstrated that a low SMD (OR 2.94; 95% CI 1.13–7.66, P = 0.027), high NLR (OR 3.96; 95% CI 1.24–12.69, P = 0.021) and both low SMD and high NLR (OR 25.58; 95% CI 2.37–276.71, P = 0.008) combined, were associated with an increased risk of death. Patients who had both low SMD and high NLR required more mechanical ventilation (P < 0.001) and were hospitalized for a longer period (P < 0.001). Low SMD, high NLR and the composite score can predict poor prognosis in patients with COVID-19, and can be used as a tool for early identification of patients at risk. Systemic inflammation and low muscle radiodensity are useful predictors of poor prognosis, and the assessment of these factors in clinical practice should be considered.

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Section: Discussionmentioning

confidence: 96%

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19

Padilha

Mendes²,

Lascala³

et al. 2022

Sci Rep

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“…This may be the consequence of prolonged hospitalisation and the impact of muscle wasting, inflammation, sepsis, and malnutrition on creatinine generation [ 34 ]. Notably, previous studies reported sarcopenia in around 1 in 4 of patients who received ECMO on admission [ 35 ]. Consequently, GFR at hospital discharge can easily be overestimated leading to suboptimal follow-up and under-recognition of GFR decline.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study

Lumlertgul

Wright

Hutson

et al. 2022

Ann. Intensive Care

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Background Acute kidney injury (AKI) is a frequent complication in patients with severe respiratory failure receiving extracorporeal membrane oxygenation (ECMO). However, little is known of long-term kidney function in ECMO survivors. We aimed to assess the long-term mortality and kidney outcomes in adult patients treated with veno-venous ECMO (VV-ECMO). Methods This was a single-centre retrospective study of adult patients (≥ 18 years old) who were treated with VV-ECMO at a commissioned ECMO centre in the UK between 1st September 2010, and 30th November 2016. AKI was defined and staged using the serum creatinine and urine output criteria of the Kidney Diseases: Improving Global Outcomes (KDIGO) classification. The primary outcome was 1-year mortality. Secondary outcomes were long-term mortality (up to March 2020), 1-year incidence of end-stage kidney disease (ESKD) or chronic kidney disease (CKD) among AKI patients who received renal replacement therapy (AKI-RRT), AKI patients who did not receive RRT (AKI-no RRT) and patients without AKI (non-AKI). Results A total of 300 patients [57% male; median age 44.5; interquartile range (IQR) 34–54] were included in the final analysis. Past medical histories included diabetes (12%), hypertension (17%), and CKD (2.3%). The main cause of severe respiratory failure was pulmonary infection (72%). AKI occurred in 230 patients (76.7%) and 59.3% received renal replacement therapy (RRT). One-year mortality was 32% in AKI-RRT patients vs. 21.4% in non-AKI patients (p = 0.014). The median follow-up time was 4.35 years. Patients who received RRT had a higher risk of 1-year mortality than those who did not receive RRT (adjusted HR 1.80, 95% CI 1.06, 3.06; p = 0.029). ESKD occurred in 3 patients, all of whom were in the AKI-RRT group. At 1-year, 41.2% of survivors had serum creatinine results available. Among these, CKD was prevalent in 33.3% of AKI-RRT patients vs. 4.3% in non-AKI patients (p = 0.004). Conclusions VV-EMCO patients with AKI-RRT had high long-term mortality. Monitoring of kidney function after hospital discharge was poor. In patients with follow-up creatinine results available, the CKD prevalence was high at 1 year, especially in AKI-RRT patients. More awareness about this serious long-term complication and appropriate follow-up interventions are required.

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“…Moreover, at day 20 there was a moderate correlation between total muscle thickness and ICU mobility scale and Medical Research Council (MRC) sum-score of muscle strength [35]. In another study by Bear DE et al, the initial condition of the skeletal muscle index of patients with ARDS was related to the duration of VV ECMO, and most specifically, low skeletal muscle index resulted in longer VV ECMO duration, while preserved initial skeletal muscle index was associated with better survival [36]. Finally, fatty muscle fraction through CT imaging seems to be a predicting biomarker of 1-year mortality and a promising muscle quality imaging biomarker in ECMO patients [37].…”

Section: Prevalence and Risk Factors Of Icu-awmentioning

confidence: 99%

Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support

Kourek

Nanas

Κοτανίδου

et al. 2022

JCDD

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The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with severe cardiac, respiratory or combined cardiorespiratory failure. Critically ill patients on ECMO very often present intensive care unit-acquired weakness (ICU-AW); thus, leading to decreased exercise capacity and increased mortality rates. Early mobilization and physical therapy have been proven to be safe and feasible in critically ill patients on ECMO, either as a bridge to lung/heart transplantation or as a bridge to recovery. Rehabilitation has beneficial effects from the early stages in the ICU, resulting in the prevention of ICU-AW, and a decrease in episodes of delirium, the duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates. It also improves functional ability, exercise capacity, and quality of life. Rehabilitation requires a very careful, multi-disciplinary approach from a highly specialized team from different specialties. Initial risk assessment and screening, with appropriate physical therapy planning and exercise monitoring in patients receiving ECMO therapy are crucial factors for achieving treatment goals. However, more randomized controlled trials are required in order to establish more appropriate individualized exercise training protocols.

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Relationship Between Skeletal Muscle Area and Density and Clinical Outcome in Adults Receiving Venovenous Extracorporeal Membrane Oxygenation

Cited by 17 publications

References 25 publications

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19

Long-term outcomes in patients who received veno-venous extracorporeal membrane oxygenation and renal replacement therapy: a retrospective cohort study

Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support

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