Lumbar skeletal muscle index derived from routine computed tomography exams predict adverse post-extubation outcomes in critically ill patients

Georg Fuchs; Tharusan Thevathasan; Yves R Chretien; Julia Mario; Annop Piriyapatsom; Ulrich Schmidt; Matthias Eikermann; Florian J Fintelmann

doi:10.1016/j.jcrc.2017.10.033

Lumbar skeletal muscle index derived from routine computed tomography exams predict adverse post-extubation outcomes in critically ill patients

J Crit Care. 2018 Apr:44:117-123. doi: 10.1016/j.jcrc.2017.10.033. Epub 2017 Oct 23.

Authors

Georg Fuchs¹, Tharusan Thevathasan², Yves R Chretien³, Julia Mario⁴, Annop Piriyapatsom⁵, Ulrich Schmidt⁶, Matthias Eikermann⁷, Florian J Fintelmann⁸

Affiliations

¹ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: Georg.Fuchs@Charite.de.
² Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
³ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: YChretien@partners.org.
⁴ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
⁵ Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: annop.pir@mahidol.ac.th.
⁶ Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: uschmidt@ucsd.edu.
⁷ Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: MEikerma@bidmc.harvard.edu.
⁸ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: fintelmann@mgh.harvard.edu.

PMID: 29096229
DOI: 10.1016/j.jcrc.2017.10.033

Abstract

Purpose: To evaluate the effect of a skeletal muscle index derived from a routine CT image at the level of vertebral body L3 (L3SMI) on outcomes of extubated patients in the surgical intensive care unit.

Materials and methods: 231 patients of a prospective observational trial (NCT01967056) who had undergone CT within 5days of extubation were included. L3SMI was computed using semi-automated segmentation. Primary outcomes were pneumonia within 30days of extubation, adverse discharge disposition and 30-day mortality. Secondary outcomes included re-intubation within 72h, total hospital costs, ICU length of stay (LOS), post-extubation LOS and total hospital LOS. Outcomes were analyzed using multivariable regression models with a priori-defined covariates height, gender, age, APACHE II score and Charlson Comorbidity Index.

Results: L3SMI was an independent predictor of pneumonia (aOR 0.96; 95% CI 0.941-0.986; P=0.002), adverse discharge disposition (aOR 0.98; 95% CI 0.957-0.999; P=0.044) and 30-day mortality (aOR 0.94; 95% CI 0.890-0.995; P=0.033). L3SMI was significantly lower in re-intubated patients (P=0.024). Secondary analyses suggest that L3SMI is associated with total hospital costs (P=0.043) and LOS post-extubation (P=0.048).

Conclusion: The lumbar skeletal muscle index, derived from routine abdominal CT, is an objective prognostic tool at the time of extubation.

Keywords: Adverse discharge disposition; Extubation; Hospital costs; Lumbar skeletal muscle index; Mortality; Pneumonia.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Critical Illness* / economics
Critical Illness* / therapy
Female
Hospital Costs
Humans
Intensive Care Units / statistics & numerical data
Intubation, Intratracheal / mortality
Intubation, Intratracheal / statistics & numerical data*
Length of Stay / statistics & numerical data
Male
Middle Aged
Mortality
Multivariate Analysis
Muscle, Skeletal / diagnostic imaging*
Pneumonia / diagnosis
Predictive Value of Tests
Prognosis
Prospective Studies
Tomography, X-Ray Computed / methods*

Associated data

ClinicalTrials.gov/NCT01967056