Yau Derek King Wai, Griffith James Francis, Underwood Malcolm John, Joynt Gavin Matthew, Lee Anna
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, 4/F Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, G/F Prince of Wales Hospital, Shatin, NT, Hong Kong SAR.
Perioper Med (Lond). 2024 May 23;13(1):45. doi: 10.1186/s13741-024-00401-y.
Frailty is common in patients undergoing cardiac surgery and is associated with poorer postoperative outcomes. Ultrasound examination of skeletal muscle morphology may serve as an objective assessment tool as lean muscle mass reduction is a key feature of frailty.
This study investigated the association of ultrasound-derived muscle thickness, cross-sectional area, and echogenicity of the rectus femoris muscle (RFM) with preoperative frailty and predicted subsequent poor recovery after surgery. Eighty-five patients received preoperative RFM ultrasound examination and frailty-related assessments: Clinical Frailty Scale (CFS) and 5-m gait speed test (GST). Association of each ultrasound measurement with frailty assessments was examined. Area under receiver-operating characteristic curve (AUROC) was used to assess the discriminative ability of each ultrasound measurement to predict days at home within 30 days of surgery (DAH).
By CFS and GST criteria, 13% and 34% respectively of participants were frail. RFM cross-sectional area alone demonstrated moderate predictive association for frailty by CFS criterion (AUROC: 0.76, 95% CI: 0.66-0.85). Specificity improved to 98.7% (95% CI: 93.6%-100.0%) by utilising RFM cross-sectional area as an 'add-on' test to a positive gait speed test, and thus a combined muscle size and function test demonstrated higher predictive performance (positive likelihood ratio: 40.4, 95% CI: 5.3-304.3) for frailty by CFS criterion than either test alone (p < 0.001). The combined 'add-on' test predictive performance for DAH (AUROC: 0.90, 95% CI: 0.81-0.95) may also be superior to either CFS or gait speed test alone.
Preoperative RFM ultrasound examination, especially when integrated with the gait speed test, may be useful to identify patients at high risk of frailty and those with poor outcomes after cardiac surgery.
The study was registered on the Chinese Clinical Trials Registry (ChiCTR2000031098) on 22 March 2020.
衰弱在接受心脏手术的患者中很常见，并且与较差的术后结果相关。骨骼肌形态的超声检查可作为一种客观评估工具，因为瘦肌肉量减少是衰弱的一个关键特征。
本研究调查了股直肌（RFM）的超声衍生肌肉厚度、横截面积和回声性与术前衰弱的关联，并预测了术后随后的恢复不佳情况。85名患者接受了术前RFM超声检查和与衰弱相关的评估：临床衰弱量表（CFS）和5米步态速度测试（GST）。检查了每项超声测量与衰弱评估的关联。采用受试者操作特征曲线下面积（AUROC）来评估每项超声测量预测术后30天内在家天数（DAH）的判别能力。
根据CFS和GST标准，分别有13%和34%的参与者衰弱。仅RFM横截面积对CFS标准下的衰弱显示出中度预测关联（AUROC：0.76，95%CI：0.66 - 0.85）。通过将RFM横截面积作为步态速度测试阳性的“附加”测试，特异性提高到98.7%（95%CI：93.6% - 100.0%），因此肌肉大小和功能的联合测试对CFS标准下的衰弱显示出比单独任何一项测试更高的预测性能（阳性似然比：40.4，95%CI：5.3 - 304.3）（p < 0.001）。联合“附加”测试对DAH的预测性能（AUROC：0.90，95%CI：0.81 - 0.95）也可能优于单独的CFS或步态速度测试。
术前RFM超声检查，尤其是与步态速度测试相结合时，可能有助于识别衰弱高危患者和心脏手术后预后不良的患者。
该研究于2020年3月22日在中国临床试验注册中心（ChiCTR2000031098）注册。
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