ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study
Abstract Background Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-020-03276-9 |
| _version_ | 1818510096254107648 |
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| author | Ariel Jaitovich Camille L. Dumas Ria Itty Hau C. Chieng Malik M. H. S. Khan Ali Naqvi John Fantauzzi Jesse B. Hall Paul J. Feustel Marc A. Judson |
| author_facet | Ariel Jaitovich Camille L. Dumas Ria Itty Hau C. Chieng Malik M. H. S. Khan Ali Naqvi John Fantauzzi Jesse B. Hall Paul J. Feustel Marc A. Judson |
| author_sort | Ariel Jaitovich |
| collection | DOAJ |
| description | Abstract Background Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density. Methods Single-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders. Results Larger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity. Conclusion In our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures. |
| first_indexed | 2024-12-10T22:54:34Z |
| format | Article |
| id | doaj.art-6f47c9309a19415dba0997c1b5cf8676 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T22:54:34Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-6f47c9309a19415dba0997c1b5cf86762022-12-22T01:30:19ZengBMCCritical Care1364-85352020-09-0124111010.1186/s13054-020-03276-9ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort studyAriel Jaitovich0Camille L. Dumas1Ria Itty2Hau C. Chieng3Malik M. H. S. Khan4Ali Naqvi5John Fantauzzi6Jesse B. Hall7Paul J. Feustel8Marc A. Judson9Division of Pulmonary and Critical Care Medicine, Albany Medical CollegeDepartment of Radiology, Albany Medical CollegeDivision of Pulmonary and Critical Care Medicine, Albany Medical CollegeDivision of Pulmonary and Critical Care Medicine, Albany Medical CollegeDivision of Pulmonary and Critical Care Medicine, Albany Medical CollegeDivision of Pulmonary and Critical Care Medicine, Albany Medical CollegeDepartment of Radiology, Albany Medical CollegeSection of Pulmonary and Critical Care, Department of Medicine, University of ChicagoDepartment of Neuroscience and Experimental Therapeutics, Albany Medical CollegeDivision of Pulmonary and Critical Care Medicine, Albany Medical CollegeAbstract Background Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density. Methods Single-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders. Results Larger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity. Conclusion In our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures.http://link.springer.com/article/10.1186/s13054-020-03276-9Skeletal muscleAdipose tissueBone densityCritical illnessMortality |
| spellingShingle | Ariel Jaitovich Camille L. Dumas Ria Itty Hau C. Chieng Malik M. H. S. Khan Ali Naqvi John Fantauzzi Jesse B. Hall Paul J. Feustel Marc A. Judson ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study Critical Care Skeletal muscle Adipose tissue Bone density Critical illness Mortality |
| title | ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study |
| title_full | ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study |
| title_fullStr | ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study |
| title_full_unstemmed | ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study |
| title_short | ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study |
| title_sort | icu admission body composition skeletal muscle bone and fat effects on mortality and disability at hospital discharge a prospective cohort study |
| topic | Skeletal muscle Adipose tissue Bone density Critical illness Mortality |
| url | http://link.springer.com/article/10.1186/s13054-020-03276-9 |
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