MHealth Fairview, University of Minnesota Medical Center, Minneapolis, MN, 55455, USA.
Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
Clin Nutr ESPEN. 2023 Jun;55:434-439. doi: 10.1016/j.clnesp.2023.04.028. Epub 2023 Apr 29.
BACKGROUND & AIMS: Prolonged length of stay (LOS) and discharge disposition following liver transplantation are associated with postoperative complications and increased healthcare utilization. This study evaluated the relationship between CT-derived psoas muscle measurements and hospital LOS, intensive care unit (ICU) LOS, and discharge disposition after liver transplant. The psoas muscle was chosen given its ease of measurement with any radiological software. A secondary analysis assessed the relationship between the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics (ASPEN/AND) malnutrition diagnosis criteria and CT-derived psoas muscle measures.
CT-derived measures of psoas muscle density (mHU) and cross-sectional area at the level of the third lumbar vertebrae were obtained from preoperative CT scans of liver transplant recipients. Cross-sectional area measures were corrected for body size to generate a psoas area index variable (cm/m; PAI).
Each 1-unit increase in PAI was associated with a reduced hospital LOS of 4 days (R = 0.07). Each 5-unit increase in mean Hounsfield units (mHU) was associated with a reduced hospital and ICU LOS of 5 and 1.6 days, respectively (R = 0.22 and 0.14, respectively). Mean PAI and mHU were higher in patients who discharged to home. PAI was reasonably identified through ASPEN/AND malnutrition criteria, but there was no difference in mHU between those with and without malnutrition.
Measures of psoas density were associated with both hospital and ICU LOS and discharge disposition. PAI was associated with hospital LOS and discharge disposition. CT-derived measures of psoas density may be a valuable complement to preoperative liver transplant nutrition assessment using traditional ASPEN/AND malnutrition criteria.
肝移植术后住院时间（LOS）延长和出院去向与术后并发症和增加的医疗保健利用有关。本研究评估了 CT 测量的腰大肌测量值与肝移植后住院时间、重症监护病房（ICU） LOS 和出院去向之间的关系。选择腰大肌是因为它可以使用任何放射学软件轻松测量。二次分析评估了美国肠外和肠内营养学会（ASPEN/AND）营养不良诊断标准与 CT 测量的腰大肌测量值之间的关系。
从肝移植受者的术前 CT 扫描中获得第三腰椎水平的腰大肌密度（mHU）和横截面积的 CT 衍生测量值。为了生成腰大肌面积指数变量（cm/m；PAI），对横截面积测量值进行了体型校正。
PAI 每增加 1 个单位，住院 LOS 减少 4 天（R=0.07）。平均 Hounsfield 单位（mHU）每增加 5 个单位，住院和 ICU LOS 分别减少 5 天和 1.6 天（R=0.22 和 0.14）。出院回家的患者的平均 PAI 和 mHU 较高。PAI 可通过 ASPEN/AND 营养不良标准合理识别，但营养不良和无营养不良患者的 mHU 无差异。
腰大肌密度的测量值与住院和 ICU LOS 以及出院去向均相关。PAI 与住院 LOS 和出院去向相关。CT 衍生的腰大肌密度测量值可能是术前肝移植营养评估中使用传统 ASPEN/AND 营养不良标准的有价值的补充。
