Chapple Lee-Anne S, Deane Adam M, Williams Lauren T, Strickland Richard, Schultz Chris, Lange Kylie, Heyland Daren K, Chapman Marianne J
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.
Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD, Australia.
Crit Care Resusc. 2017 Mar;19(1):29-36.
Patients admitted to the ICU with a traumatic brain injury (TBI) are at risk of muscle wasting but this has not been quantified. Our aims were to describe longitudinal changes in anthropometrical data, compare the accuracy of non-invasive methodologies to the validated dual-energy x-ray absorptiometry (DXA), and assess the relationships between anthropometrical data and self-reported physical function.
In a prospective observational study, we recruited patients admitted to the ICU with a moderate-to-severe TBI over 12 months. Anthropometric measurements included the subjective global assessment (SGA), bodyweight and ultrasoundderived quadriceps muscle layer thickness (QMLT), which we performed weekly in hospital and 3 months after admission. We assessed total body composition using DXA within 7 days of ICU discharge, and compared the total lean muscle mass with ultrasound-derived QMLT taken within 5 days of the DXA measurement. We assessed functional outcomes at 3 months using the physical component score of the Short Form-36 (SF- 36) and the Extended Glasgow Outcome Scale (GOS-E).
Thirty-seven patients were included, with a mean age of 45 years (SD, 16 years), and 87% were men. Participants were admitted to the ICU for a mean of 13 days (IQR, 6-18 days) and to hospital for a mean of 38 days (IQR, 19-52 days). They had significant weight loss in hospital (mean, 4.9% [SD, 7.7%]; P = 0.001). Malnutrition, measured with the SGA, was twice as prevalent at hospital discharge than at admission (P = 0.005). A reduction in QMLT occurred in the ICU but stabilised after ICU discharge. DXA-derived total lean mass taken within 7 days of ICU discharge strongly correlated with ultrasound-derived QMLT taken within 5 days of DXA measurements (ρ = 0.74, P = 0.037). Improvements in self-reported physical function, using the SF- 36 and GOS-E at 3 months, were associated with a greater QMLT at hospital discharge (SF-36: ρ = 0.536, P = 0.010; GOS-E: ρ = 0.595, P = 0.003, n = 23) and at 3 months (SF-36: ρ = 0.658, P = 0.020; GOS-E: ρ = 0.642, P = 0.025, n = 12).
Patients with a TBI lose muscle thickness while in the ICU but the trajectory of loss stabilises after ICU discharge. Ultrasound-derived QMLT is related to total lean mass and physical function after discharge. Further studies are needed to confirm that ultrasound measurement of QMLT is a useful surrogate measure of muscle mass and functional outcomes after trauma and critical illness.
因创伤性脑损伤（TBI）入住重症监护病房（ICU）的患者存在肌肉萎缩风险，但尚未进行量化评估。我们的目的是描述人体测量数据的纵向变化，比较非侵入性方法与经过验证的双能X线吸收法（DXA）的准确性，并评估人体测量数据与自我报告的身体功能之间的关系。
在一项前瞻性观察性研究中，我们招募了12个月内因中度至重度TBI入住ICU的患者。人体测量包括主观全面评定（SGA）、体重和超声测量的股四头肌层厚度（QMLT），我们在患者住院期间每周进行一次测量，并在出院后3个月进行测量。我们在ICU出院后7天内使用DXA评估全身成分，并将总瘦肌肉质量与DXA测量前5天内超声测量的QMLT进行比较。我们在3个月时使用简短健康调查问卷36项版本（SF - 36）的身体成分得分和扩展格拉斯哥预后量表（GOS - E）评估功能结局。
纳入37例患者，平均年龄45岁（标准差16岁），87%为男性。参与者在ICU平均住院13天（四分位间距，6 - 18天），住院平均38天（四分位间距，19 - 52天）。他们在住院期间体重显著下降（平均，4.9% [标准差，7.7%]；P = 0.001）。用SGA测量的营养不良在出院时的发生率是入院时的两倍（P = 0.005）。ICU期间QMLT降低，但在ICU出院后趋于稳定。ICU出院后7天内通过DXA测量的总瘦肌肉质量与DXA测量前5天内超声测量的QMLT密切相关（ρ = 0.74，P = 0.037）。在3个月时，使用SF - 36和GOS - E自我报告的身体功能改善与出院时更大的QMLT相关（SF - 36：ρ = 0.536，P = 0.010；GOS - E：ρ = 0.595，P = 0.003，n = 23）以及3个月时相关（SF - 36：ρ = 0.658，P = 0.020；GOS - E：ρ = 0.642，P = 0.025，n = 12）。
TBI患者在ICU期间肌肉厚度会降低，但在ICU出院后肌肉量减少的轨迹趋于稳定。超声测量的QMLT与出院后的总瘦肌肉质量和身体功能相关。需要进一步研究以证实超声测量QMLT是创伤和危重症后肌肉质量和功能结局的有用替代指标。
