Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients
Abstract Objectives SARS-CoV-2 virus infection can lead to acute respiratory distress syndrome (ARDS), which can be complicated by severe muscle wasting. Until now, data on muscle loss of critically ill COVID-19 patients are limited, while computed tomography (CT) scans for clinical follow-up are av...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-07-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-023-01162-5 |
| _version_ | 1827905324167725056 |
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| author | Johannes Kolck Zvonimir A. Rako Nick L. Beetz Timo A. Auer Laura K. Segger Christian Pille Tobias Penzkofer Uli Fehrenbach Dominik Geisel |
| author_facet | Johannes Kolck Zvonimir A. Rako Nick L. Beetz Timo A. Auer Laura K. Segger Christian Pille Tobias Penzkofer Uli Fehrenbach Dominik Geisel |
| author_sort | Johannes Kolck |
| collection | DOAJ |
| description | Abstract Objectives SARS-CoV-2 virus infection can lead to acute respiratory distress syndrome (ARDS), which can be complicated by severe muscle wasting. Until now, data on muscle loss of critically ill COVID-19 patients are limited, while computed tomography (CT) scans for clinical follow-up are available. We sought to investigate the parameters of muscle wasting in these patients by being the first to test the clinical application of body composition analysis (BCA) as an intermittent monitoring tool. Materials BCA was conducted on 54 patients, with a minimum of three measurements taken during hospitalization, totaling 239 assessments. Changes in psoas- (PMA) and total abdominal muscle area (TAMA) were assessed by linear mixed model analysis. PMA was calculated as relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan. Cox regression was applied to analyze associations with survival. Receiver operating characteristic (ROC) analysis and Youden index were used to define a decay cut-off. Results Intermittent BCA revealed significantly higher long-term PMA loss rates of 2.62% (vs. 1.16%, p < 0.001) and maximum muscle decay of 5.48% (vs. 3.66%, p = 0.039) per day in non-survivors. The first available decay rate did not significantly differ between survival groups but showed significant associations with survival in Cox regression (p = 0.011). In ROC analysis, PMA loss averaged over the stay had the greatest discriminatory power (AUC = 0.777) for survival. A long-term PMA decline per day of 1.84% was defined as a threshold; muscle loss beyond this cut-off proved to be a significant BCA-derived predictor of mortality. Conclusion Muscle wasting in critically ill COVID-19 patients is severe and correlates with survival. Intermittent BCA derived from clinically indicated CT scans proved to be a valuable monitoring tool, which allows identification of individuals at risk for adverse outcomes and has great potential to support critical care decision-making. |
| first_indexed | 2024-03-13T00:40:02Z |
| format | Article |
| id | doaj.art-c62d6ebc0a8f43b29828bc6cc683fecc |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-13T00:40:02Z |
| publishDate | 2023-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-c62d6ebc0a8f43b29828bc6cc683fecc2023-07-09T11:24:56ZengSpringerOpenAnnals of Intensive Care2110-58202023-07-0113111110.1186/s13613-023-01162-5Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patientsJohannes Kolck0Zvonimir A. Rako1Nick L. Beetz2Timo A. Auer3Laura K. Segger4Christian Pille5Tobias Penzkofer6Uli Fehrenbach7Dominik Geisel8Department of Radiology, Charité - Universitätsmedizin BerlinDepartment of Pneumology and Intensive Care, Universities of Giessen and Giessen Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Department of Radiology, Charité - Universitätsmedizin BerlinDepartment of Radiology, Charité - Universitätsmedizin BerlinDepartment of Radiology, Charité - Universitätsmedizin BerlinDepartment of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charité - Universitätsmedizin BerlinDepartment of Radiology, Charité - Universitätsmedizin BerlinDepartment of Radiology, Charité - Universitätsmedizin BerlinDepartment of Radiology, Charité - Universitätsmedizin BerlinAbstract Objectives SARS-CoV-2 virus infection can lead to acute respiratory distress syndrome (ARDS), which can be complicated by severe muscle wasting. Until now, data on muscle loss of critically ill COVID-19 patients are limited, while computed tomography (CT) scans for clinical follow-up are available. We sought to investigate the parameters of muscle wasting in these patients by being the first to test the clinical application of body composition analysis (BCA) as an intermittent monitoring tool. Materials BCA was conducted on 54 patients, with a minimum of three measurements taken during hospitalization, totaling 239 assessments. Changes in psoas- (PMA) and total abdominal muscle area (TAMA) were assessed by linear mixed model analysis. PMA was calculated as relative muscle loss per day for the entire monitoring period, as well as for the interval between each consecutive scan. Cox regression was applied to analyze associations with survival. Receiver operating characteristic (ROC) analysis and Youden index were used to define a decay cut-off. Results Intermittent BCA revealed significantly higher long-term PMA loss rates of 2.62% (vs. 1.16%, p < 0.001) and maximum muscle decay of 5.48% (vs. 3.66%, p = 0.039) per day in non-survivors. The first available decay rate did not significantly differ between survival groups but showed significant associations with survival in Cox regression (p = 0.011). In ROC analysis, PMA loss averaged over the stay had the greatest discriminatory power (AUC = 0.777) for survival. A long-term PMA decline per day of 1.84% was defined as a threshold; muscle loss beyond this cut-off proved to be a significant BCA-derived predictor of mortality. Conclusion Muscle wasting in critically ill COVID-19 patients is severe and correlates with survival. Intermittent BCA derived from clinically indicated CT scans proved to be a valuable monitoring tool, which allows identification of individuals at risk for adverse outcomes and has great potential to support critical care decision-making.https://doi.org/10.1186/s13613-023-01162-5Critical careCOVID-19Muscle wastingArtificial intelligenceBody composition analysisComputed tomography |
| spellingShingle | Johannes Kolck Zvonimir A. Rako Nick L. Beetz Timo A. Auer Laura K. Segger Christian Pille Tobias Penzkofer Uli Fehrenbach Dominik Geisel Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients Annals of Intensive Care Critical care COVID-19 Muscle wasting Artificial intelligence Body composition analysis Computed tomography |
| title | Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients |
| title_full | Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients |
| title_fullStr | Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients |
| title_full_unstemmed | Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients |
| title_short | Intermittent body composition analysis as monitoring tool for muscle wasting in critically ill COVID-19 patients |
| title_sort | intermittent body composition analysis as monitoring tool for muscle wasting in critically ill covid 19 patients |
| topic | Critical care COVID-19 Muscle wasting Artificial intelligence Body composition analysis Computed tomography |
| url | https://doi.org/10.1186/s13613-023-01162-5 |
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