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. 2021 Jun;133(11-12):529-535.
doi: 10.1007/s00508-020-01736-4. Epub 2020 Sep 18.

Morphometric parameters of muscle and bone in critically ill patients : Post hoc analysis of the VITdAL-ICU trial

Oliver Malle  1 , Dietmar Maurer  2 , Doris Wagner  3 , Christian Schnedl  4 , Steven Amrein  5 , Thomas Pieber  2 , Astrid Fahrleitner-Pammer  2 , Hans Peter Dimai  2 , Karin Amrein  2
Affiliations

Morphometric parameters of muscle and bone in critically ill patients : Post hoc analysis of the VITdAL-ICU trial

Oliver Malle et al. Wien Klin Wochenschr. 2021 Jun.

Abstract

Background: Sarcopenia, defined as loss of muscle mass, quality and function, is a part of the frailty syndrome. In critical illness, sarcopenia has rarely been evaluated regarding clinical outcomes. Therefore, we evaluated the association of sarcopenia with both hospital length of stay (HLOS) and 6‑month mortality in critically ill patients using abdominal computed tomography (CT) scans.

Methods: In a post hoc analysis from the high dose vitamin D3 vs. placebo in adult vitamin D deficient patients (VITdAL-ICU) trial, we retrospectively reviewed all available abdominal CT scans (18 women, 19 men). We measured and calculated total psoas area (TPA), psoas muscle density (PMD), skeletal muscle index (SMI) and bone mineral density (BMD) and analyzed the relation of these endpoints with HLOS and mortality. Defining sarcopenia we used cut-off values for TPA as 642.1 mm2/m2 in women and 784 mm2/m2 in men and PMD as 31.1 Hounsfield units (HU) in women and 33.3 HU in men, both measured at the level of L3, as well as for SMI (38.5 cm2/m2 in women and 52.4 cm2/m2 in men). Likely osteoporosis was defined by L1 trabecular attenuation of ≤110 HU. Values for TPA, PMD and SMI could not be obtained in 11 patients and BMD in 1 patient.

Results: Mean adjusted TPA was lower in women versus men (478 vs. 749 mm2/m2) as well as PMD (34.6 vs. 41.3 HU), SMI (62.36 vs. 76.81 cm2/m2) and BMD (141.1 vs. 157.2 HU). No significant influence on hospital length of stay and on 6‑month mortality was found, irrespective of the morphometric parameter used (TPA, PMD, SMI, BMD; p > 0.05). Survivors showed statistically nonsignificantly better values than nonsurvivors: TPA: 652 vs. 530 mm2/m2 (p = 0.27); PMD: 38.4 vs. 37.4 HU (p = 0.85); SMI: 70.32 vs. 69.54 cm2/m2 (p = 0.91); BMD: 156 vs. 145.8 HU (p = 0.81).

Conclusion: Although the study is limited by the small sample size, our data do not support a strong predictive value for TPA/PMD/SMI or BMD for HLOS or mortality in critically ill patients with vitamin D deficiency.

Keywords: Intensive care; Mortality; Sarcopenia; Skeletal muscle index; Total psoas area.

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Conflict of interest statement

O. Malle, D. Maurer, D. Wagner, C. Schnedl, S. Amrein, T. Pieber, A. Fahrleitner-Pammer, H.P. Dimai, and K. Amrein declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cross-sectional X-ray image at the L3 level showing measurement of TPA in the psoas muscles (marked green)
Fig. 2
Fig. 2
Cross-sectional X-ray image at the L3 level showing measurement of SMI (marked red)
Fig. 3
Fig. 3
Sagittal cross-sectional X-ray image showing measurement of BMD at L1 (marked green)
Fig. 4
Fig. 4
Cross-sectional X-ray image showing measurement of BMD at L1 (marked green)
Fig. 5
Fig. 5
Distribution of a TPA, b PMD, c SMI and d BMD in men and women
Fig. 6
Fig. 6
Distribution of a TPA, b PMD, c SMI and d BMD among age
See this image and copyright information in PMC

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