Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Nutrition. 2021 Sep;89:111229. doi: 10.1016/j.nut.2021.111229. Epub 2021 Mar 4.
The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma.
Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed.
Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm/m for men and 37.35 cm/m for women). Low skeletal muscle mass was significantly associated with longer hospital length of stay, longer intensive care length of stay, higher cost, higher frequency of mechanical ventilation, longer duration of vasopressor use, and higher incidence of massive transfusion and overall complications (P < 0.05). Subgroup analysis showed that pneumonia, acute gastrointestinal dysfunction, cholecystitis, digestive tract fistula, gastric fistula, and intestinal fistula were significantly associated with low skeletal muscle mass (P < 0.05). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for overall complications (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.33-4.49; P = 0.004), hospital length of stay (OR, 3.49; 95% CI, 1.96-6.20; P < 0.001), and hospital cost (OR, 2.67; 95% CI, 1.48-4.80; P = 0.001).
Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.
本研究旨在探讨低骨骼肌量是否与腹部创伤患者的临床结局相关。
回顾性纳入 2010 年 1 月至 2020 年 4 月我院收治的腹部创伤患者。低骨骼肌量采用计算机断层扫描（CT），根据入院 1 周内第三腰椎以下最低性别四分位数以下的骨骼肌指数（SMI）定义。记录并发症、住院时间和住院费用等临床结局，并进行单因素和多因素分析。
在 684 例患者中，451 例符合条件。其中，根据 SMI 诊断界值（男性 42.08cm/m，女性 37.35cm/m），112 例（24.8%）归类为低骨骼肌量。低骨骼肌量与住院时间延长、重症监护时间延长、费用增加、机械通气频率增加、血管活性药物使用时间延长、大量输血和总并发症发生率较高显著相关（P<0.05）。亚组分析显示，肺炎、急性胃肠功能障碍、胆囊炎、消化道瘘、胃瘘和肠瘘与低骨骼肌量显著相关（P<0.05）。多因素分析显示，低骨骼肌量是总并发症的独立危险因素（比值比[OR]，2.44；95%置信区间[CI]，1.33-4.49；P=0.004）、住院时间（OR，3.49；95%CI，1.96-6.20；P<0.001）和住院费用（OR，2.67；95%CI，1.48-4.80；P=0.001）。
低骨骼肌量可能是腹部创伤患者临床结局不良的独立预测因子。
