Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan; Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
Am J Emerg Med. 2021 Sep;47:180-186. doi: 10.1016/j.ajem.2021.04.011. Epub 2021 Apr 20.
This study aimed to determine the association between sarcopenic findings of the psoas muscle and mortality in patients with sepsis; further, it aimed to assess its clinical utility, in addition to the sequential organ failure assessment (SOFA) score, in predicting mortality.
This retrospective single-center cohort study included adult patients with sepsis, who were admitted to the intensive care unit, between January 2012 and December 2018. The cross-sectional area of the psoas muscle at the L3 level was measured using computed tomography (CT) images, following which the subjects were categorized as "Above middle," "Middle," and "Sarcopenic." The association between sarcopenic findings and 90-day mortality was investigated by logistic regression analysis. A "modified SOFA score," by adding sarcopenic findings to the SOFA score, was developed and evaluated for its predictive performance.
Here, 255 patients with sepsis, who were admitted to the intensive care unit (median age, 76 [64-84] years; SOFA score, 9 [5-14]), were included. The adjusted odds ratio for the "Middle" and "Sarcopenic" groups for 90-day mortality was 2.40 (95% confidence interval [CI]: 0.93-6.15) and 3.67 (95% CI: 1.39-9.68), respectively. The c-statistics of the SOFA and modified SOFA score was 0.731 [95% CI: 0.650-0.799] and 0.749 [95% CI: 0.673-0.813]. On decision curve analysis, a little additional net benefit was observed on using the modified SOFA score.
The results suggested an association of the sarcopenic findings of the psoas muscle on CT imaging with 90-day mortality; however, the modified SOFA had few additional clinical values to that of SOFA in predicting 90-day mortality.
本研究旨在确定腹直肌的肌肉减少症发现与脓毒症患者死亡率之间的关联；此外，评估其临床效用，除了序贯器官衰竭评估（SOFA）评分外，在预测死亡率方面的效用。
本回顾性单中心队列研究纳入了 2012 年 1 月至 2018 年 12 月期间入住重症监护病房的成年脓毒症患者。使用计算机断层扫描（CT）图像测量 L3 水平的腰大肌横截面积，随后将受试者分为“高于中值”、“中值”和“肌肉减少症”。通过逻辑回归分析调查肌肉减少症发现与 90 天死亡率之间的关联。通过添加肌肉减少症发现来修改 SOFA 评分，制定并评估其预测性能。
本研究共纳入 255 名入住重症监护病房的脓毒症患者（中位年龄 76 [64-84] 岁；SOFA 评分 9 [5-14]）。对于 90 天死亡率，“中值”和“肌肉减少症”组的调整后比值比为 2.40（95%置信区间 [CI]：0.93-6.15）和 3.67（95% CI：1.39-9.68）。SOFA 和改良 SOFA 评分的 C 统计量分别为 0.731（95% CI：0.650-0.799）和 0.749（95% CI：0.673-0.813）。在决策曲线分析中，使用改良 SOFA 评分观察到稍微增加了净收益。
结果表明 CT 成像上的腰大肌肌肉减少症发现与 90 天死亡率相关；然而，与 SOFA 相比，改良 SOFA 在预测 90 天死亡率方面的临床价值有限。
