Joyce Patrick R, O'Dempsey Ryan, Kirby Giles, Anstey Christopher
Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Australia.
Department of Medical Imaging, Sunshine Coast University Hospital, Sunshine Coast, Australia.
Anaesth Intensive Care. 2020 May;48(3):229-235. doi: 10.1177/0310057X20922234. Epub 2020 Jun 2.
Frailty assessment in patients admitted to intensive care is often limited using traditional clinical frailty assessment tools. Opportunistic use of contemporary computed tomography (CT) can provide an objective estimate of low skeletal muscle mass (sarcopenia) as a proxy for frailty. The aim of this study was to establish the prevalence of sarcopenia in an Australian intensive care unit (ICU) population and to examine the relationship between sarcopenia and clinical outcomes. We undertook a single centre retrospective study of 1085 adult patients admitted to a single ICU over 12 months. Patients with a contemporary CT scan including the L3 vertebral body were included. Patients were categorised as sarcopenic or non-sarcopenic using previously published data. A total of 279 patients with a mean age of 67 years had an eligible CT scan; 163 (58%) were male. Higher 30-day mortality was associated with the use of CRRT (continuous renal replacement therapy) during the ICU admission (OR 6.84, < 0.001) and also associated with lower cross-sectional muscle area (odds ratio (OR) 0.98, = 0.004). Sarcopenia was found to be highly prevalent in this particular Australian ICU population (68%) and associated with older age (68 versus 55 years, < 0.001), lower body mass index (27 versus 32 kg m, < 0.001), more comorbidities (3 versus 2, = 0.009), and longer stays in hospital (279 versus 223 h, = 0.043). As a continuous predictor, lumbar muscle mass was associated with 30-day mortality with and without adjusting for other covariates.
在重症监护病房收治的患者中，使用传统的临床衰弱评估工具进行衰弱评估往往存在局限性。适时利用现代计算机断层扫描（CT）可以客观估计低骨骼肌量（肌肉减少症），以此作为衰弱的替代指标。本研究的目的是确定澳大利亚重症监护病房（ICU）人群中肌肉减少症的患病率，并研究肌肉减少症与临床结局之间的关系。我们对一家ICU在12个月内收治的1085例成年患者进行了单中心回顾性研究。纳入有包括L3椎体的现代CT扫描的患者。根据先前发表的数据将患者分为肌肉减少症患者或非肌肉减少症患者。共有279例平均年龄为67岁的患者进行了符合要求的CT扫描；其中163例（58%）为男性。ICU住院期间使用连续性肾脏替代治疗（CRRT）与30天死亡率较高相关（比值比[OR] 6.84，P<0.001），同时也与较低的横断面肌肉面积相关（比值比[OR] 0.98，P=0.004）。在这个特定的澳大利亚ICU人群中，肌肉减少症的患病率很高（68%），并且与年龄较大（68岁对55岁，P<0.001）、较低的体重指数（27 kg/m²对32 kg/m²，P<0.001）、更多的合并症（3种对2种，P=0.009）以及更长的住院时间（279小时对223小时，P=0.043）相关。作为连续预测指标，无论是否调整其他协变量，腰椎肌肉量都与30天死亡率相关。
