Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients

Abstract

Background Critically-ill surgical patients are at higher risk for sarcopenia, which is associated with worse survival. Sarcopenia may impair the respiratory musculature, which can subsequently influence the outcome of ventilator weaning. Although there are a variety of weaning parameters predictive of weaning outcomes, none have tried to incorporate “muscle strength” or “sarcopenia”. The aim of the current study was to explore the association between sarcopenia and difficult-to-wean (DtW) in critically-ill surgical patients. The influence of sarcopenia on ICU mortality was also analyzed. Methods Ninety-six patients undergoing mechanical ventilation in the surgical intensive care unit (ICU) were enrolled. Demographic data and weaning parameters were recorded from the prospectively collected database, and the total psoas muscle area (TPA) was determined at the level of the 3 rd lumbar vertebra by computed tomography. Sarcopenia was defined by previously established cut-off points and its influence on clinical outcomes was examined. Receiver operating characteristic (ROC) curve analysis was conducted to investigate the predictive capability of TPA and weaning parameters for predicting weaning outcomes. Results The median age of the studied patients was 73 years. Thirty patients (31.3%) were sarcopenic and 30 (31.3%) were defined as DtW. Eighteen patients (18.8%) had ICU mortality. Multivariate logistic regression analyses revealed that sarcopenia was an independent risk factor for DtW and ICU mortality. The area under the ROC curve (AUC) of TPA for predicting successful weaning was 0.727 and 0.720 in female and male patients, respectively. After combining TPA and conventional weaning parameters, the AUC for DtW increased from 0.836 to 0.911 and from 0.835 to 0.922 in female and male patients, respectively. Conclusion Sarcopenia is an independent risk factor for DtW and ICU mortality. TPA has predictive value when assessing weaning outcomes and can be used as an effective adjunct predictor along with conventional weaning parameters.

The Utility of Psoas Muscle Assessment in Predicting Frailty in Patients Undergoing Transcatheter Aortic Valve Replacement

“…In this patient, the PLVI was mean psoas area (mm 2 )/vertebral body area (mm 2 ) ((695 + 708)/2)/1110 � 0.63. 4 Current Gerontology and Geriatrics Research [41][42][43], but there is some conflicting evidence regarding whether the psoas area is truly representative of the global skeletal muscle area [44]. Its routine use, particularly, in research studies, is, in part, secondary to convenience and simplicity of acquiring measurements, but it is suggested in the literature that the total lumbar muscle area may be more closely related to the overall muscle mass, and given that psoas comprises only 10% of the total trunk musculature, this may not be accurate [45,46].…”

Association of low alanine aminotransferase values with extubation failure in adult critically ill patients: A retrospective cohort study

“…(9) Using the same method of sarcopenia assessment, Kou et al found that sarcopenia was associated with prolonged weaning (more than seven days of weaning after the rst SBT) or need for reintubation within 48 hours after extubation in critically ill surgical patients in Taiwan. (8) There is no gold standard for sarcopenia assessment in the ICU. Although muscle mass can be measured by either bioelectrical impedance, dual X-ray absorptiometry, CT, magnetic resonance imaging, and ultrasonography, all these methods are preliminary research tools; their bedside and routine use is complex in ICU settings and limited to clinical trials.…”

“…Previous studies have shown that decreased muscle mass and sarcopenia are associated with extubation failure and di culty in MV liberation. (8)(9)(10) These studies evaluated muscle mass using measurement of different skeletal muscle diameter on abdominal computed tomography (CT). However, CT-based analysis of body muscle mass has some prominent limitations such as radiation exposure, high cost, and the need to transport the patient outside of the ICU.…”

Sarcopenia as A Predictor of Mortality Among the Critically Ill in an Intensive Care Unit: A Systematic Review and Meta-Analysis

“…All of the studies that were included were retrospective cohort studies, with the exception of one 34 , which was a prospective cohort study. A total of ve studies was conducted in the U.S. 10,23,24,33,34 ; while China 21,22 , Japan 17,35 , and the Netherlands 11,18 each had two studies, and Korea 20 , Australia 25 , and Brazil 19 each had one study respectively. All studies used CT to detect sarcopenia.…”

“…There were several outcomes reported in our meta-analysis. Seven studies used in-hospital mortality 10,11,18,17,21,23,34 , four studies used 30-day mortality 19,22,25,35 , and three studies used 1-year mortality 20,24,33 . The proportion of males among the studies that were included ranged from 51.40% to 61.40% (Table 1).…”