Jiang Jie, Chen Hui, Meng Shan-Shan, Pan Chun, Xie Jian-Feng, Guo Feng-Mei
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
Department of Critical Care Medicine, Nanjing Central Hospital, Nanjing, 210018, China.
BMC Anesthesiol. 2025 Jan 11;25(1):26. doi: 10.1186/s12871-025-02892-8.
Patients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis.
This retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss.
Of the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68-0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR.
The results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss.
重症监护病房（ICU）中的脓毒症患者常出现快速肌肉流失。尿素与肌酐比值（UCR）被认为可反映肌肉分解（肌酐）和分解代谢（尿素）情况，常用于评估营养和代谢状况。本研究旨在调查UCR变化（ΔUCR）能否预测脓毒症患者快速肌肉流失的发生。
本回顾性观察性研究于2014年至2021年在一所大学的ICU进行，纳入诊断为脓毒症的成年患者（≥18岁）。主要结局是ICU住院期间快速肌肉流失的发生率。使用CT图像测量第三腰椎横截面肌肉面积（L3SMA）的变化以评估肌肉流失。快速肌肉流失定义为ΔL3SMA每天变化大于2%。采用多变量逻辑回归分析UCR或ΔUCR与快速肌肉流失之间的关联。计算受试者工作特征曲线（AUC）下面积，以评估UCR或ΔUCR对快速肌肉流失的预测性能。
482例患者中，141例（29.2%）在ICU住院期间出现快速肌肉流失。多变量逻辑回归分析显示，ΔUCR与快速肌肉流失风险增加显著相关，比值比（OR）为1.02 [95%置信区间：1.01, 1.02]。ΔUCR预测快速肌肉流失的AUC为0.76 [95%置信区间：0.68 - 0.83]，ΔUCR的阈值为19.4 μmol尿素/μmol肌酐。
结果表明，ΔUCR与脓毒症患者的快速肌肉流失独立相关，ΔUCR预测快速肌肉流失能力的ROC曲线AUC为0.76。尽管需要更多前瞻性数据，但我们的结果表明，ΔUCR可能有助于早期识别有快速肌肉流失风险的脓毒症重症患者。
