Pita Alejandro, Ziogas Ioannis A, Ye Fei, Chen Yufan, Rauf Muhammad A, Matsuoka Lea K, Kaur Navpreet, Whang Gilbert, Zielsdorf Shannon M, Bastas Gerasimos, Izzy Manhal, Alexopoulos Sophoclis P
Department of Surgery, Division of Hepatobiliary and Abdominal Transplant Surgery, University of Southern California, Los Angeles, CA.
Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN.
Transplant Direct. 2020 Oct 20;6(11):e618. doi: 10.1097/TXD.0000000000001067. eCollection 2020 Nov.
End-stage liver disease (ESLD) patients requiring intensive care unit (ICU) care before liver transplantation (LT) often experience significant muscle mass loss, which has been associated with mortality. In this exploratory study, we primarily aimed to assess the feasibility of serial ultrasound (US) rectus femoris muscle area (RFMA) measurements for the evaluation of progressive muscle loss in ICU-bound potential LT candidates and describe the rate of muscle loss as assessed by sequential US RFMA measurements. Secondarily, we sought to identify patient characteristics associated with muscle loss and determine how muscle loss is associated with survival.
We prospectively enrolled 50 ESLD adults (≥18 y old) undergoing evaluation for LT candidacy in the ICU. A baseline computed tomography measurement of psoas muscle area (PMA) and serial bedside US measurements of RFMA were obtained. The associations between patient characteristics, PMA, RFMA, ICU stay, and survival were analyzed.
Rapid decline in muscle mass by RFMA measurements was ubiquitously present and correlated to baseline PMA and length of ICU stay. RFMA normalized by body surface area decreased by 0.013 cm/m (95% confidence interval, 0.010-0.016; < 0.001) for each day in the ICU. Decreased RFMA normalized by body surface area was associated with poor overall survival (adjusted hazard ratio, 0.42; 95% confidence interval, 0.18-0.99; = 0.047).
In this exploratory, prospective study, serial US RFMA measurements in ESLD patients in the ICU are feasible, demonstrate progressive time-dependent muscle loss, and are associated with mortality. Further large-scale assessment of this modality compared with static PMA or performance-based dynamic assessments should be performed.
需要在肝移植（LT）前接受重症监护病房（ICU）护理的终末期肝病（ESLD）患者常出现显著的肌肉量减少，这与死亡率相关。在这项探索性研究中，我们主要旨在评估连续超声（US）测量股直肌肌肉面积（RFMA）以评估即将入住ICU的潜在LT候选者进行性肌肉减少的可行性，并描述通过连续US测量RFMA评估的肌肉减少率。其次，我们试图确定与肌肉减少相关的患者特征，并确定肌肉减少与生存率的关系。
我们前瞻性纳入了50名在ICU接受LT候选资格评估的成年ESLD患者（≥18岁）。获得了腰大肌面积（PMA）的基线计算机断层扫描测量值和RFMA的连续床边US测量值。分析了患者特征、PMA、RFMA、ICU住院时间和生存率之间的关联。
通过RFMA测量发现肌肉量迅速下降普遍存在，且与基线PMA和ICU住院时间相关。在ICU中，每住院一天，经体表面积标准化的RFMA下降0.013 cm/m²（95%置信区间，0.010 - 0.016；P < 0.001）。经体表面积标准化的RFMA降低与总体生存率差相关（调整后的风险比，0.42；95%置信区间，0.18 - 0.99；P = 0.047）。
在这项探索性的前瞻性研究中，对ICU中的ESLD患者进行连续US RFMA测量是可行的，显示出随时间进展的肌肉减少，并且与死亡率相关。应进一步对这种方法与静态PMA或基于表现的动态评估进行大规模评估。
