Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY; Department of Molecular and Cell Physiology, Albany Medical College, Albany, NY.
Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY.
Chest. 2019 Feb;155(2):322-330. doi: 10.1016/j.chest.2018.10.023. Epub 2018 Oct 28.
BACKGROUND: Skeletal muscle dysfunction occurring as a result of ICU admission associates with higher mortality. Although preadmission higher BMI correlates with better outcomes, the impact of baseline muscle and fat mass has not been defined. We therefore investigated the association of skeletal muscle and fat mass at ICU admission with survival and disability at hospital discharge. METHODS: This single-center, prospective, observational cohort study included medical ICU (MICU) patients from an academic institution in the Unites States. A total of 401 patients were evaluated with pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) determinations conducted by CT scanning at the time of ICU admission, which were later correlated with clinical outcomes accounting for potential confounders. RESULTS: Larger admission PMA was associated with better outcomes, including higher 6-month survival (OR, 1.03; 95% CI, 1.01-1.04; P < .001), lower hospital mortality (OR, 0.96; 95% CI, 0.93-0.98; P < .001), and more ICU-free days (slope, 0.044 ± 0.019; P = .021). SAT was not significantly associated with any of the measured outcomes. In multivariable analyses, PMA association persisted with 6 months and hospital survival and ICU-free days, whereas SAT remained unassociated with survival or other outcomes. PMA was not associated with regaining of independence at the time of hospital discharge (OR, 0.99; 95% CI, 0.98-1.01; P = .56). CONCLUSIONS: In this study cohort, ICU admission PMA was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes.
背景：因入住 ICU 而导致的骨骼肌功能障碍与更高的死亡率相关。尽管入院前较高的 BMI 与更好的预后相关，但基线肌肉和脂肪量的影响尚未确定。因此，我们研究了 ICU 入院时骨骼肌和脂肪量与出院时的存活率和残疾率之间的关系。
方法：这项单中心、前瞻性、观察性队列研究纳入了来自美国一所学术机构的内科重症监护病房（MICU）患者。共有 401 名患者接受了胸部肌肉面积（PMA）和皮下脂肪组织（SAT）的评估，这些评估是通过 ICU 入院时的 CT 扫描进行的，随后将这些评估结果与考虑到潜在混杂因素的临床结果相关联。
结果：入院时较大的 PMA 与更好的结果相关，包括更高的 6 个月生存率（比值比，1.03；95%置信区间，1.01-1.04；P<0.001）、较低的医院死亡率（比值比，0.96；95%置信区间，0.93-0.98；P<0.001）和更多的 ICU 无天数（斜率，0.044±0.019；P=0.021）。SAT 与任何测量结果均无显著相关性。在多变量分析中，PMA 与 6 个月和医院生存率以及 ICU 无天数的相关性仍然存在，而 SAT 与生存率或其他结果仍无相关性。PMA 与出院时恢复独立性无关（比值比，0.99；95%置信区间，0.98-1.01；P=0.56）。
结论：在本研究队列中，ICU 入院时的 PMA 与危重病期间和之后的生存率相关；它无法预测出院后恢复独立生活的能力。ICU 入院时的 SAT 质量与生存率或其他测量结果无关。
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