Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.
Aust Crit Care. 2024 Mar;37(2):205-211. doi: 10.1016/j.aucc.2023.06.008. Epub 2023 Jul 31.
Older individuals are at an increased risk of delayed recovery following a traumatic injury. Measurement of muscularity and frailty at hospital admission may aid with prognostication and risk stratification.
This study aimed to describe muscularity at intensive care unit (ICU) admission in patients admitted following trauma and assess the relationship between muscularity and clinical, long-term functional outcomes and frailty at ICU admission.
This retrospective study utilised data from a prospective observational study investigating frailty in patients aged ≥50 years, admitted to the ICU following trauma. Patients were eligible if they had a Computed Tomography (CT) scan including the third lumbar vertebra at ICU admission. Specialist software was used to quantify CT-derived skeletal muscle cross-sectional area. Muscularity status was classified as normal or low using published sex-specific cut-points. Demographic data, frailty, clinical, and long-term functional outcomes (Glasgow Outcome Scale-Extended and EQ-5DL-5L Visual analogue scale and utility score) were extracted from the original study.
One hundred patients were screened; 71 patients had a CT scan on admission with 66 scans suitable for muscle assessment. Patients with low muscularity (n = 25, 38%) were older and had a higher Acute Physiology and Chronic Health Evaluation II score and lower body mass index than patients with normal muscularity. Low muscularity was associated with frailty at admission (32% vs 5%, p = 0.005) but not with long term outcomes at 6 or 12 months. As a continuous variable, lower muscle cross-sectional area was associated with a poorer outcome on the Glasgow Outcome Scale-Extended at 6 months (mean [standard deviation]: 150 [43] and 180 [44], respectively; p = 0.014), no association was observed after adjustment for age p = 0.43).
In a population of older adults hospitalised following trauma, low muscularity at ICU admission was prevalent. Low muscularity was associated with frailty but not long-term functional outcomes. Larger studies are warranted to better understand the relationship between muscularity and long-term functional outcomes.
老年人在创伤后恢复延迟的风险增加。在入院时测量肌肉量和虚弱程度可能有助于预测和风险分层。
本研究旨在描述创伤后入住重症监护病房（ICU）的患者入院时的肌肉量，并评估肌肉量与 ICU 入院时的临床和长期功能结局以及虚弱之间的关系。
这项回顾性研究利用了一项前瞻性观察研究中调查 50 岁以上患者虚弱情况的数据，这些患者因创伤入住 ICU。如果患者在 ICU 入院时进行了包括第三腰椎在内的 CT 扫描，则符合入选标准。使用专业软件来量化 CT 衍生的骨骼肌横截面积。使用已发表的性别特异性切点将肌肉量状态分类为正常或低。从原始研究中提取人口统计学数据、虚弱、临床和长期功能结局（格拉斯哥预后扩展量表和 EQ-5D-L5L 视觉模拟量表和效用评分）。
共筛选了 100 名患者；71 名患者入院时进行了 CT 扫描，其中 66 名患者的扫描适合肌肉评估。肌肉量低的患者（n=25，38%）年龄较大，急性生理学和慢性健康评估 II 评分较高，体质指数较低。肌肉量低与入院时的虚弱有关（32%比 5%，p=0.005），但与 6 个月或 12 个月的长期结局无关。作为连续变量，较低的肌肉横截面积与 6 个月时格拉斯哥预后扩展量表的预后较差相关（平均[标准差]：150[43]和 180[44]，分别；p=0.014），调整年龄后无关联，p=0.43）。
在因创伤住院的老年人群中，ICU 入院时的低肌肉量很常见。低肌肉量与虚弱有关，但与长期功能结局无关。需要更大的研究来更好地理解肌肉量与长期功能结局之间的关系。
