Bradford James M, Cardenas Tatiana C P, Lara Sabino, Olson Kristofor, Teixeira Pedro G, Aydelotte Jayson D, Trust Marc D, DuBose Joseph, Ali Sadia, Brown Carlos Vr
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA.
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, USA.
Injury. 2023 Apr;54(4):1102-1105. doi: 10.1016/j.injury.2023.02.004. Epub 2023 Feb 7.
Sarcopenia is a clinically relevant loss of muscle mass with implications of increased morbidity and mortality in adult trauma populations. Our study aimed to evaluate loss of muscle mass change in adult trauma patients with prolonged hospital stays.
Retrospective analysis using institutional trauma registry to identify all adult trauma patients with hospital length of stay >14 days admitted to our Level 1 center between 2010 and 2017. All CT images were reviewed, and cross-sectional area (cm) of the left psoas muscle was measured at the level of the third lumbar vertebral body to determine total psoas area (TPA) and Total Psoas Index (TPI) normalized for patient stature. Sarcopenia was defined as a TPI on admission below gender specific thresholds of 5.45(cm/m) in men and 3.85(cm/m) in women. TPA, TPI, and rates of change in TPI were then evaluated and compared between sarcopenic and non-sarcopenic adult trauma patients.
There were 81 adult trauma patients who met inclusion criteria. The average change in TPA was -3.8 cm and TPI was -1.3 cm. On admission, 23% (n = 19) of patients were sarcopenic while 77% (n = 62) were not. Non-sarcopenic patients had a significantly greater change in TPA (-4.9 vs. -0.31, p<0.0001), TPI (-1.7 vs. -0.13, p<0.0001), and rate of decrease in muscle mass (p = 0.0002). 37% of patients who were admitted with normal muscle mass developed sarcopenia during admission. Older age was the only risk factor independently associated with developing sarcopenia (OR: 1.04, 95%CI 1.00-1.08, p = 0.045).
Over a third of patients with normal muscle mass at admission subsequently developed sarcopenia with older age as the primary risk factor. Patients with normal muscle mass at admission had greater decreases in TPA and TPI, and accelerated rates of muscle mass loss compared to sarcopenic patients.
肌肉减少症是临床上与肌肉量流失相关的病症，会增加成年创伤患者的发病率和死亡率。我们的研究旨在评估住院时间延长的成年创伤患者的肌肉量变化情况。
采用机构创伤登记系统进行回顾性分析，以确定2010年至2017年间入住我们一级中心、住院时间超过14天的所有成年创伤患者。回顾所有CT图像，在第三腰椎椎体水平测量左侧腰大肌的横截面积（平方厘米），以确定总腰大肌面积（TPA）和根据患者身高标准化的总腰大肌指数（TPI）。肌肉减少症的定义为入院时TPI低于男性5.45（平方厘米/米）和女性3.85（平方厘米/米）的性别特异性阈值。然后评估并比较肌肉减少症和非肌肉减少症成年创伤患者的TPA、TPI及TPI变化率。
有81名成年创伤患者符合纳入标准。TPA的平均变化为-3.8平方厘米，TPI为-1.3平方厘米。入院时，23%（n = 19）的患者患有肌肉减少症，而77%（n = 62）的患者没有。非肌肉减少症患者的TPA（-4.9对-0.31，p<0.0001）、TPI（-1.7对-0.13，p<0.0001）和肌肉量减少率（p = 0.0002）有显著更大的变化。37%入院时肌肉量正常的患者在住院期间出现了肌肉减少症。年龄较大是与发生肌肉减少症独立相关的唯一危险因素（OR：1.04，95%CI 1.00 - 1.08，p = 0.045）。
超过三分之一入院时肌肉量正常的患者随后发展为肌肉减少症，年龄较大是主要危险因素。入院时肌肉量正常的患者与肌肉减少症患者相比，TPA和TPI下降幅度更大，肌肉量流失速度更快。
