Validation of Psoas Muscle Index as a predictor of successful extubation in elderly intensive care patients: a retrospective cohort study

2020 ◽  
Author(s):  
Fumimasa Kobori ◽  
Kazunari Azuma ◽  
Shiro Mishima ◽  
Jun Oda
Keyword(s):  
Intensive Care ◽  
Psoas Muscle ◽  
Extubation Failure ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Predictive Values ◽  
Failure Group ◽  
Success Group ◽  
Sensitivity Specificity

Abstract Background Extubation failure-associated factors haven't been investigated in elderly patients. We hypothesized that psoas cross-sectional area, an emerging indicator of frailty, can be a predictor of extubation outcomes. Methods This retrospective study analyzed data from patients admitted between January and April 2016 at the intensive care unit (ICU) of the Tokyo Medical University Hospital. Patients were considered eligible if aged ≥65 years, required intubation at the emergency room, and were admitted to ICU for <24 h. Overall, 39 ICU patients were eligible and categorized into two groups: extubation success (n = 24) and extubation failure (n = 15) groups. The psoas cross-sectional area was measured at the third lumbar level on computer tomography images. Regions of interest were drawn freehand to outline the left and right psoas by an emergency physician. The average left and right psoas cross-sectional areas, used as the patient’s psoas cross-sectional area, were calculated. Psoas Muscle Index (PMI) was defined as the psoas cross-sectional area/height 2 . Primary outcome was to evaluate differences between the psoas cross-sectional area and f(PMI) between the groups, if any. Secondary outcome was to derive cut-off values using ROC curves. Results Both groups were comparable in terms of demographic characteristics. Psoas cross-sectional area (success group, 1776.5 ± 498.2 mm 2 , failure group, 1391.2 ± 589.4 mm 2 ; p = 0.022) and PMI (success group, 1089 ± 270.7 mm 2 /m 2 , failure group, 889 ± 338.5 mm 2 /m 2 ; p = 0.032) were significantly greater in the success group than in the failure group. ROC curve of the psoas cross-sectional area and PMI were used to calculate sensitivity and specificity. ROC AUC was 0.74 for psoas cross-sectional area, and at a cut-off of 1260 points, the sensitivity, specificity, and positive and negative predictive values were 95.8%, 60.0%, 79.3%, and 90.0%, respectively. ROC AUC for PMI was 0.73, and at a cut-off of 812 points, the sensitivity, specificity, and positive and negative predictive values were 95.8%, 46.7%, 74.2%, and 87.5%, respectively. Conclusions The psoas cross-sectional area and PMI can predict extubation outcomes in elderly intensive care patients.

Predictors of All-Cause Mortality after Endovascular Aneurysm Repair: Assessing the Role of Psoas Muscle Cross-Sectional Area

2019 ◽  
Vol 30 (12) ◽  
pp. 1972-1979 ◽  
Author(s):  
Timothy C. Huber ◽  
Nicole Keefe ◽  
James Patrie ◽  
Margaret C. Tracci ◽  
Daniel Sheeran ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
Aneurysm Repair ◽  
Muscle Cross Sectional Area

scholarly journals Psoas Muscle Volume as an Opportunistic Diagnostic Tool to Assess Sarcopenia in Patients with Hip Fractures: A Retrospective Cohort Study

2021 ◽  
Vol 11 (12) ◽  
pp. 1338
Author(s):  
Sang-Pil So ◽  
Bum-Sik Lee ◽  
Ji-Wan Kim
Keyword(s):  
Skeletal Muscle ◽  
Hip Fractures ◽  
Diagnostic Tool ◽  
Retrospective Cohort ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Muscle Volume ◽  
Sectional Area ◽  
Muscle Area ◽  
Cross Sectional

Purpose: This study aims to determine whether the psoas volume measured from a pelvic computed tomography (CT) could be a potential opportunistic diagnostic tool to measure muscle mass and sarcopenia in patients with hip fractures. Methods: This was a retrospective cohort study. In total; 57 consecutive patients diagnosed with hip fractures who underwent surgery were enrolled. A cross-sectional area of the psoas muscle was measured at the lumbar (L) 3 and L4 vertebrae from a pelvic CT for the diagnosis of hip fractures. The psoas muscle volume was calculated with a three-dimensional modeling software program. The appendicular skeletal muscle mass (ASM) and preoperative handgrip strength (HS) were measured. The correlations between the psoas muscle volume/area and ASM/HS were assessed. Data on patient demographics; postoperative complication; length of hospital stay; and Koval scores were also recorded and analyzed with respect to the psoas muscle area/volume. Results: The psoas muscle volume and adjusted values were significantly correlated with ASM; which showed a stronger correlation than the psoas muscle area did at the L3 or L4 level. HS was correlated with the psoas volume or adjusted values; but not with the cross-sectional area of the psoas muscle. Among the adjusted values; the psoas muscle volume adjusted for the patient’s height (m2) showed a strongest correlation with ASM and HS. The psoas muscle volume was not significantly correlated with postoperative complications or short-term functional outcomes. Conclusions: The psoas muscle volume measured from a pelvic CT for the diagnosis of hip fractures showed a stronger correlation with ASM and HS than the cross-sectional area did. Therefore; the psoas muscle volume could be a potential diagnostic tool to assess the quantity of the skeletal muscle in patients with hip fractures without an additional examination.

scholarly journals Severe Lumbar Disability Is Associated With Decreased Psoas Cross-Sectional Area in Degenerative Spondylolisthesis

2018 ◽  
Vol 8 (7) ◽  
pp. 716-721 ◽  
Author(s):  
Scott C. Wagner ◽  
Arjun S. Sebastian ◽  
James C. McKenzie ◽  
Joseph S. Butler ◽  
Ian D. Kaye ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Severe Disability ◽  
Sectional Area ◽  
Paraspinal Muscles ◽  
Cross Sectional ◽  
Potential Association ◽  
Magnetic Resonance Imaging Mri

Study Design: Retrospective cohort. Objectives: Alterations in lumbar paraspinal muscle cross-sectional area (CSA) may correlate with lumbar pathology. The purpose of this study was to compare paraspinal CSA in patients with degenerative spondylolisthesis and severe lumbar disability to those with mild or moderate lumbar disability, as determined by the Oswestry Disability Index (ODI). Methods: We retrospectively reviewed the medical records of 101 patients undergoing lumbar fusion for degenerative spondylolisthesis. Patients were divided into ODI score ≤40 (mild/moderate disability, MMD) and ODI score >40 (severe disability, SD) groups. The total CSA of the psoas and paraspinal muscles were measured on preoperative magnetic resonance imaging (MRI). Results: There were 37 patients in the SD group and 64 in the MMD group. Average age and body mass index were similar between groups. For the paraspinal muscles, we were unable to demonstrate any significant differences in total CSA between the groups. Psoas muscle CSA was significantly decreased in the SD group compared with the MMD group (1010.08 vs 1178.6 mm2, P = .041). Multivariate analysis found that psoas CSA in the upper quartile was significantly protective against severe disability ( P = .013). Conclusions: We found that patients with severe lumbar disability had no significant differences in posterior lumbar paraspinal CSA when compared with those with mild/moderate disability. However, severely disabled patients had significantly decreased psoas CSA, and larger psoas CSA was strongly protective against severe disability, suggestive of a potential association with psoas atrophy and worsening severity of lumbar pathology.

scholarly journals Asymmetry of the cross-sectional area of paravertebral and psoas muscle in patients with degenerative scoliosis

2013 ◽  
Vol 22 (6) ◽  
pp. 1332-1338 ◽  
Author(s):  
Hyoungmin Kim ◽  
Choon-Ki Lee ◽  
Jin S. Yeom ◽  
Jae Hyup Lee ◽  
Jae Hwan Cho ◽  
...  
Keyword(s):  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Degenerative Scoliosis ◽  
Cross Sectional ◽  
The Cross

Carpal tunnel syndrome diagnosed using ultrasound as a first-line exam by the surgeon

2012 ◽  
Vol 38 (6) ◽  
pp. 627-632 ◽  
Author(s):  
J. Lange
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
First Line ◽  
Cross Sectional ◽  
Predictive Values ◽  
Ultrasound Evaluation ◽  
Tunnel Syndrome

This study evaluates the diagnostic value of ultrasound as a first-line exam in carpal tunnel syndrome. In 16 patients with carpal tunnel syndrome and 32 matched controls, evaluation of the median nerve was performed by the cross-sectional area at wrist level and wrist–forearm ratio. This study found statistically significant differences between patients and controls by both methods, and both showed high specificity and positive predictive values. Optimal cut-off values were identified at a 14 mm2 cross-sectional area and a 1.6 wrist–forearm ratio. This study implies that ultrasound evaluation of the median nerve is a valuable tool as a first-line diagnostic test used by the surgeon for examination of patients with presumed carpal tunnel syndrome. Owing to the high positive predictive value of ultrasound, the need for referral to nerve conduction study may be limited.

220. The cross-sectional area of psoas muscle impacts functional outcomes of MI-TLIF for lumbar degenerative diseases

2020 ◽  
Vol 20 (9) ◽  
pp. S109
Author(s):  
Hikari Urakawa ◽  
Kosuke Sato ◽  
Avani S. Vaishnav ◽  
Ryan Lee ◽  
Chirag Chaudhary ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Degenerative Diseases ◽  
Sectional Area ◽  
Cross Sectional ◽  
Lumbar Degenerative Diseases ◽  
The Cross

scholarly journals Evaluation of Sarcopenia by Ultrasound of the Rectus Femoris Muscle as a Predictor of Outcomes of Surgical Intensive Care Unit Patients, A Prospective, Observational Study

2021 ◽  
pp. 43-52
Author(s):  
Aya Hassan Hegazy ◽  
Mohammad Samir Abd El-Ghafar ◽  
Nagat Sayed El-shmaa ◽  
Sohair Moustafa Soliman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Rectus Femoris ◽  
Cross Sectional Area ◽  
Surgical Intensive Care Unit ◽  
Sectional Area ◽  
Surgical Intensive Care ◽  
Cross Sectional ◽  
Rectus Femoris Muscle ◽  
Femoris Muscle

Background: Muscle wasting is a frequent finding in critically ill patients and is associated with worse short- and long term outcomes. Loss of mass and function of skeletal muscles starts early - in the first 24 hours after admission to Intensive Care Unit (ICU) - and may persist for years ‘Post-ICU syndrome’. Ultrasound of rectus femoris muscle is a valid and simple technique that could be used for longitudinal assessment of treatment success and facilitates the use of postoperative interventions that help in problems related to critical illness. The aim of this study is to evaluate sarcopenia by ultrasound of rectus femoris muscle as a predictor of outcomes of surgical intensive care unit. Materials and Methods: This prospective observational study was performed on 40 patients admitted to the surgical ICU, Tanta University Hospitals, Egypt, after approval of the Institutional Ethical Committee, Tanta University. The study started from April 2019 till January 2020. An informed consent was taken from the nearest relatives of the patients. All data of the patients was confidential with secret codes and private files for each patient. All given data was used for the current medical research only. Any unexpected risks appeared during the course of the research were cleared to the participants and ethical committee at time. Results: Cross-sectional area of rectus femoris muscle decreased significantly at all-time measurements as compared to the baseline at day 0 (within 24 hours from SICU admission), 5, 10, 15, 20, 25 and 30. There were negative correlations between delta cross-sectional area of rectus femoris muscle and age, height, weight, Body Mass Index and baseline cross-sectional area of rectus femoris muscle. There was a positive correlation between delta cross-sectional area of rectus femoris muscle and duration of mechanical ventilation, ICU length of stay and mortality. Conclusion: Rectus femoris cross-sectional area measured by B-mode ultrasonography showed significant role in nutritional assessment as it decreases in critically ill patients with positive correlation with duration of mechanical ventilation and ICU stay.

Psoas Cross-Sectional Area As Radiographic Measure Of Sarcopenia Does Not Predict Overall Survival In Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5326-5326
Author(s):  
Pavan Kumar Bhamidipati ◽  
Kenneth R Carson ◽  
Tanya M Wildes
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Muscle Mass ◽  
Psoas Muscle ◽  
Cross Sectional Area ◽  
Whole Body ◽  
Sectional Area ◽  
Cross Sectional ◽  
Muscle Density ◽  
Pet Ct

Abstract Introduction Although various disease-related markers have been implemented in the prognosis of multiple myeloma, nutritional or physical characteristics have not been utilized in the assessment for prognosis. Sarcopenia, defined as loss of lean skeletal muscle mass, is prognostic in non-malignant diseases such as COPD and non-hematologic malignancies such as breast cancer and pancreatic cancer. For the first time, we sought to analyze the prognostic value of sarcopenia in multiple myeloma (MM) by utilizing PET / CT scans done around the time of diagnosis. Methods In this retrospective cohort study, we identified all patients diagnosed and treated for multiple myeloma from 2000-2010 from the Barnes-Jewish Hospital Oncology Data Services registry, then identified patients who had undergone cross-sectional imaging (CT or PET/CT) for diagnostic purposes within 2 months of diagnosis. Medical records were reviewed for clinical and anthropomorphic data. The radiographic images were accessed to manually measure the psoas muscle cross sectional area (PCA) at the level of 3rdlumbar vertebra (L3) by a single trained person. This landmark was chosen as the PCA at the level of L3 correlates with the whole–body lean muscle mass in previous studies (Mourtzakis M, 2008 PMID: 18923576).The psoas muscle density was identified based on the average CT Hounsfield units for the cross-sectional area being measured. This value was then normalized for stature based on height to calculate L3 muscle index (LMI)(Total Psoas Area (TPA), in cm2/m2). Overall survival was defined as the time from diagnosis to death from any cause, censored at last follow-up. Survival between tertiles of LMI was compared using the methods of Kaplan-Meier and the Log-Rank test. Results A total of 129 MM patients with radiographic imaging were identified (median age 61 years, range 32-91; 57% males; 66% white race, 31.8% black race). The median body mass index (BMI) was 28.7, range 16.6-49.9). Of the 93 patients with staging information available, 27% had ISS stage 1, 36.6% stage II, 36.6% stage III. The median OS for the entire cohort was 34.2 months (95% Confidence Intervals 23.5-45.0 months). Survival did not differ between the tertiles of LMI: median OS 26.9 months (95% CI 9.2-44.6) in lowest tertile of TPA, 54.1 months (95% CI 30.6-77.6) in middle tertile and 38.2 months in highest tertile [Log-rank c21.439, p=0.487]. We then evaluated psoas muscle density in the 56 patients who underwent abdominal CT imaging without intravenous contrast. Survival did not differ between the tertiles of psoas density: median OS 24.3 months (95% CI 10.3-38.2) in the lowest tertile, 33.8 months (95% CI 14.8-52.8) in middle tertile, and 44.8 months (95% CI 25.8 – 53.5) in the highest tertile, p=0.122. Conclusion Total psoas area and psoas density as a measure of sarcopenia did not predict overall survival in this cohort. Limitations of this study include the fact that patients underwent imaging for diagnostic purposes at clinician. Future study will evaluate whether radiographic measures of sarcopenia in a less selected MM population have prognostic utility. Disclosures: Carson: Spectrum Pharmaceuticals: Honoraria, Research Funding, Speakers Bureau.

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