Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Intensive Care Medicine, Laurentius hospital, Roermond, the Netherlands.
School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
Nutrition. 2021 Sep;89:111238. doi: 10.1016/j.nut.2021.111238. Epub 2021 Mar 7.
Changes in muscle mass and quality are important targets for nutritional intervention in critical illness. Effects of such interventions may be assessed using sequential computed tomography (CT) scans. However, fluid and lipid infiltration potentially affects muscle area measurements. The aim of this study was to evaluate changes in muscle mass and quality in critical illness with special emphasis on the influence of edema on this assessment.
Changes in skeletal muscle area index (SMI) and radiation attenuation (RA) at the level of vertebra L3 were analyzed using sequential CT scans of 77 patients with abdominal sepsis. Additionally, the relation between these changes and disease severity using the maximum Sequential Organ Failure Assessment (SOFA) score and change in edema were studied.
SMI declined on average 0.35%/d (±1.22%; P = 0.013). However, SMI increased in 41.6% of the study population. Increasing edema formation was significantly associated with increased SMI and with a higher SOFA score. Muscle RA decreased during critical illness, but was not significantly associated with changes in SMI or changes in edema.
In critically ill patients, edema affects skeletal muscle area measurements, which leads to an overestimation of skeletal muscle area. A higher SOFA score was associated with edema formation. Because both edema and fat infiltration may affect muscle RA, the separate effects of these on muscle quality are difficult to distinguish. When using abdominal CT scans to changes in muscle mass and quality in critically ill patients, researchers must be aware and careful with the interpretation of the results.
肌肉质量和功能的改变是危重病患者营养干预的重要目标。这种干预的效果可以通过连续的计算机断层扫描（CT）来评估。然而，液体和脂肪浸润可能会影响肌肉面积的测量。本研究的目的是评估危重病患者的肌肉质量和功能变化，特别强调水肿对这种评估的影响。
对 77 例腹部脓毒症患者的连续 CT 扫描，分析了腰椎 L3 水平骨骼肌面积指数（SMI）和辐射衰减（RA）的变化。此外，还研究了这些变化与疾病严重程度（使用最大序贯器官衰竭评估（SOFA）评分和水肿变化）之间的关系。
SMI 平均每天下降 0.35%（±1.22%；P=0.013）。然而，在研究人群中有 41.6%的患者 SMI 增加。水肿形成的增加与 SMI 的增加和更高的 SOFA 评分显著相关。危重病期间肌肉 RA 降低，但与 SMI 的变化或水肿的变化无显著相关性。
在危重病患者中，水肿会影响骨骼肌面积的测量，从而导致骨骼肌面积的高估。较高的 SOFA 评分与水肿形成有关。由于水肿和脂肪浸润都可能影响肌肉 RA，因此很难区分这些因素对肌肉质量的单独影响。当使用腹部 CT 扫描来评估危重病患者的肌肉质量和功能变化时，研究人员必须注意并谨慎解释结果。
