Kelm Diana J, Bonnes Sara L, Jensen Michael D, Eiken Patrick W, Hathcock Matthew A, Kremers Walter K, Kennedy Cassie C
Division of Pulmonary Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Clin Transplant. 2016 Mar;30(3):247-55. doi: 10.1111/ctr.12683. Epub 2016 Feb 11.
Frailty in non-transplant populations increases morbidity and mortality. Muscle wasting is an important frailty characteristic. Low body mass index is used to measure wasting, but can over- or underestimate muscle mass. Computed tomography (CT) software can directly measure muscle mass. It is unknown if muscle wasting is important in lung transplantation.
The aim of this single-center, retrospective cohort study was to determine whether pre-transplant low muscle mass (as measured by CT using Slice-O-matic software at L2-L3 interspace) was associated with post-transplantation mortality, hospital and intensive care unit length of stay (LOS), duration of mechanical ventilation, or primary graft dysfunction. Lung transplant recipients from 2000 to 2012 with a CT scan less than six months prior to transplant were included. Univariate, multivariate, and Kaplan-Meier analyses were conducted.
Thirty-six patients were included. Those with low muscle index (lower 25th percentile) had a worse survival (hazard ratio = 3.83; 95% confidence interval 1.42-10.3; p = 0.007) and longer hospital LOS by an estimated 7.2 d (p = 0.01) when adjusted for age and sex as compared to those with higher muscle index.
Low muscle index at lung transplantation is associated with worse survival and increased hospital LOS.
非移植人群中的衰弱会增加发病率和死亡率。肌肉萎缩是衰弱的一个重要特征。低体重指数用于衡量消瘦情况，但可能高估或低估肌肉量。计算机断层扫描（CT）软件可直接测量肌肉量。肌肉萎缩在肺移植中是否重要尚不清楚。
这项单中心回顾性队列研究的目的是确定移植前低肌肉量（通过使用Slice - O - matic软件在L2 - L3间隙进行CT测量）是否与移植后死亡率、住院时间和重症监护病房住院时间（LOS）、机械通气持续时间或原发性移植功能障碍相关。纳入2000年至2012年移植前六个月内进行过CT扫描的肺移植受者。进行了单因素、多因素和Kaplan - Meier分析。
纳入36例患者。与肌肉指数较高者相比，肌肉指数低（低于第25百分位数）的患者在调整年龄和性别后生存率更差（风险比 = 3.83；95%置信区间1.42 - 10.3；p = 0.007），住院LOS估计延长7.2天（p = 0.01）。
肺移植时低肌肉指数与较差的生存率和更长的住院LOS相关。
