Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Asia Pac J Clin Nutr. 2023 Dec;32(4):417-425. doi: 10.6133/apjcn.202312_32(4).0006.
To evaluate the relationship between acute muscle wasting rate and long-term mortality in critically ill trauma.
A single-center, retrospective study was conducted in critically ill trauma. Patients with Computed Tomography scans including the L3 vertebra within 24 hours and at 1 week after trauma were recruited. Acute muscle wasting rate was defined as the mean percent variation per day of skeletal muscle index in the first week after trauma. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether acute muscle wasting rate could help predict hospital malnutrition and 1-year mortality.
Skeletal muscle index was 49.3±10.7 cm2/m2 at baseline and decreased to 45.1±9.6 cm2/m2 (p<0.001) at 1 week and 39.8±10.8cm2/m2 (p<0.001) at 1 month after trauma. A sustained decrease of skeletal muscle index was observed from baseline up to 6 months (33.7±8.4cm2/m2, p<0.001) post trauma, and lasted for 1 year (37.7±5.6cm2/m2, p=0.004). Logistic regression analysis showed that acute muscle wasting rate was an independent risk factor for hospital malnutrition and 1-year mortality. Every 1% absolute increase of acute muscle wasting rate was associated with 1.82-fold higher odds of 1-year mortality in critically ill trauma. The area under curve of acute muscle wasting rate was 0.813 for hospital malnutrition prediction and 0.715 for 1-year mortality prediction.
Acute muscle wasting rate was independently associated with higher 1-year mortality and hospital malnutrition in critically ill trauma.
评估创伤危重症患者急性肌肉消耗率与长期死亡率的关系。
对创伤危重症患者进行单中心回顾性研究。招募了在创伤后 24 小时内和 1 周内接受包括 L3 椎体 CT 扫描的患者。急性肌肉消耗率定义为创伤后第 1 周内骨骼肌指数的每日平均变化百分比。采用多变量逻辑回归分析和受试者工作特征曲线分析来确定急性肌肉消耗率是否有助于预测医院营养不良和 1 年死亡率。
基线时骨骼肌指数为 49.3±10.7cm2/m2，1 周时降至 45.1±9.6cm2/m2(p<0.001)，1 个月时降至 39.8±10.8cm2/m2(p<0.001)。创伤后 6 个月内（33.7±8.4cm2/m2，p<0.001）一直观察到骨骼肌指数持续下降，且持续 1 年（37.7±5.6cm2/m2，p=0.004）。Logistic 回归分析表明，急性肌肉消耗率是医院营养不良和 1 年死亡率的独立危险因素。急性肌肉消耗率每增加 1%，创伤危重症患者 1 年死亡率的几率就增加 1.82 倍。急性肌肉消耗率预测医院营养不良和 1 年死亡率的曲线下面积分别为 0.813 和 0.715。
急性肌肉消耗率与创伤危重症患者较高的 1 年死亡率和医院营养不良独立相关。
