Wang Shengqi, Wang Meiping, Jiang Li
Department of Emergency Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Abdom Radiol (NY). 2024 Dec 17. doi: 10.1007/s00261-024-04741-7.
The trend of muscle wasting in patients with acute severe and moderately severe pancreatitis (AP) remains unclear. This retrospective study aimed to investigate the trend of skeletal muscle area (SMA) changes and its impact on patients with severe and moderately severe AP.
Patients diagnosed with AP who had repeated CT scans after intensive care unit (ICU) admission were included. The patients were categorized into moderately severe AP or severe AP groups. The generalized additive mixed model (GAMM) was used to analyze the SMA trajectories.
A total of 126 patients were included. The patients in the severe AP group had more rapid muscle wasting during the first 3 weeks following ICU admission. The SMA decreased by 1.1 cm (95% CI: 1.3 to 0.8) per day in the severe AP group, while the SMA decreased by 0.5 cm (95% CI: 0.6 to 0.4) in the moderately severe AP group in the GAMM model. A larger change in the SMA during the first 10 days after admission was significantly associated with prolonged length of hospital stay (LOS) (β = - 0.205, P = 0.036).
Patients with severe AP experienced more muscle wasting during the first 3 weeks after ICU admission. A larger reduction in the SMA was associated with prolonged LOS.
Different patterns of muscle wasting were present during the first 3 weeks after ICU admission in moderately severe and severe AP patients. Accordingly, different nutrition and rehabilitation strategies might be employed depending upon the severity of AP.
急性重症和中重症胰腺炎（AP）患者肌肉消瘦的趋势尚不清楚。本回顾性研究旨在调查骨骼肌面积（SMA）变化趋势及其对重症和中重症AP患者的影响。
纳入在重症监护病房（ICU）入院后接受重复CT扫描的AP诊断患者。患者分为中重症AP组或重症AP组。采用广义相加混合模型（GAMM）分析SMA轨迹。
共纳入126例患者。重症AP组患者在ICU入院后的前3周肌肉消瘦更快。在GAMM模型中，重症AP组SMA每天下降1.1 cm（95%CI：1.3至0.8），而中重症AP组SMA每天下降0.5 cm（95%CI：0.6至0.4）。入院后前10天SMA的较大变化与住院时间（LOS）延长显著相关（β = -0.205，P = 0.036）。
重症AP患者在ICU入院后的前3周肌肉消瘦更明显。SMA的较大减少与LOS延长相关。
中重症和重症AP患者在ICU入院后的前3周存在不同的肌肉消瘦模式。因此，可能需要根据AP的严重程度采用不同的营养和康复策略。
