肌肉脂肪浸润预测 COVID-19 患者的短期死亡率：一项多中心分析。

Myosteatosis predicts short-term mortality in patients with COVID-19: A multicenter analysis.

机构信息

Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum, Germany.

Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.

出版信息

Nutrition. 2024 Apr;120:112327. doi: 10.1016/j.nut.2023.112327. Epub 2023 Dec 9.

DOI:10.1016/j.nut.2023.112327

PMID:38341908

Abstract

OBJECTIVES

Body composition on computed tomography can predict prognosis in patients with COVID-19. The reported data are based on small retrospective studies. The aim of the present study was to analyze the prognostic relevance of skeletal muscle parameter derived from chest computed tomography for prediction of 30-d mortality in patients with COVID-19 in a multicenter setting.

METHODS

The clinical databases of three centers were screened for patients with COVID-19 between 2020 and 2022. Overall, 447 patients (142 female; 31.7%) were included into the study. The mean age at the time of computed tomography acquisition was 63.8 ± 14.7 y and median age was 65 y. Skeletal muscle area and skeletal muscle density were defined on level T12 of the chest.

RESULTS

Overall, 118 patients (26.3%) died within the 30-d observation period. Of the patient sample, 255 patients (57.0%) were admitted to an intensive care unit and 122 patients needed mechanical ventilation (27.3%). The mean skeletal muscle area of all patients was 96.1 ± 27.2 cm² (range = 23.2-200.7 cm²). For skeletal muscle density, the mean was 24.3 ± 11.1 Hounsfield units (range = -5.6 to 55.8 Hounsfield units). In survivors, the mean skeletal muscle density was higher compared with the lethal cases (mean 25.8 ± 11.2 versus 20.1 ± 9.6; P < 0.0001). Presence of myosteatosis was independently associated with 30-d mortality: odds ratio = 2.72 (95% CI, 1.71-4.32); P = 0.0001.

CONCLUSIONS

Myosteatosis is strongly associated with 30-d mortality in patients COVID-19. Patients with COVID-19 with myosteatosis should be considered a risk group.

摘要

目的

计算机断层扫描的身体成分可以预测 COVID-19 患者的预后。报告的数据基于小型回顾性研究。本研究的目的是分析从胸部计算机断层扫描中得出的骨骼肌参数对预测 COVID-19 患者 30 天死亡率的预后相关性，该研究在多中心环境中进行。

方法

筛选了 2020 年至 2022 年期间三个中心的 COVID-19 患者的临床数据库。共有 447 名患者（142 名女性；31.7%）纳入本研究。进行计算机断层扫描时的平均年龄为 63.8 ± 14.7 岁，中位数年龄为 65 岁。在胸部 T12 水平定义骨骼肌面积和骨骼肌密度。

结果

总体而言，有 118 名患者（26.3%）在 30 天观察期内死亡。在患者样本中，255 名患者（57.0%）入住重症监护病房，122 名患者需要机械通气（27.3%）。所有患者的平均骨骼肌面积为 96.1 ± 27.2 cm²（范围=23.2-200.7 cm²）。对于骨骼肌密度，平均值为 24.3 ± 11.1 Hounsfield 单位（范围=-5.6 至 55.8 Hounsfield 单位）。在幸存者中，骨骼肌密度平均值高于致死病例（平均 25.8 ± 11.2 与 20.1 ± 9.6；P < 0.0001）。存在肌脂肪增多症与 30 天死亡率独立相关：优势比=2.72（95%置信区间，1.71-4.32）；P=0.0001。