Association between Neurologic Outcomes and Changes of Muscle Mass Measured by Brain Computed Tomography in Neurocritically Ill Patients.

Yun Im Lee,Keumhee C Carriere,Ryoung-Eun Ko,Joonghyun Ahn,Jeong-Am Ryu

doi:10.3390/jcm11010090

Yun Im Lee, Keumhee C Carriere + Show 3 more

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https://doi.org/10.3390/jcm11010090

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Abstract

This study aimed to investigate whether skeletal muscle mass estimated via brain computed tomography (CT) could predict neurological outcomes in neurocritically ill patients. This is a retrospective, single-center study. Adult patients admitted to the neurosurgical intensive care unit (ICU) from January 2010 to September 2019 were eligible. Cross-sectional areas of paravertebral muscles at the first cervical vertebra level (C1-CSA) and temporalis muscle thickness (TMT) on brain CT were measured to evaluate skeletal muscle mass. The primary outcome was the Glasgow Outcome Scale score at 3 months. Among 189 patients, 81 (42.9%) patients had favorable neurologic outcomes. Initial and follow-up TMT values were higher in patients with favorable neurologic outcomes compared to those with poor outcomes (p = 0.003 and p = 0.001, respectively). The initial C1-CSA/body surface area was greater in patients with poor neurological outcomes than in those with favorable outcomes (p = 0.029). In multivariable analysis, changes of C1-CSA and TMT were significantly associated with poor neurological outcomes. The risk of poor neurologic outcome was especially proportional to changes of C1-CSA and TMT. The follow-up skeletal muscle mass measured via brain CT at the first week from ICU admission may help predict poor neurological outcomes in neurocritically ill patients.

Highlights

Nutrition is an important factor in the management of critically ill patients [1–3].Malnutrition is associated with prolonged hospitalization and duration of mechanical ventilation, infection, and mortality in the intensive care unit (ICU) [2,4,5]
Age and Acute Physiology and Chronic Health Evaluation (APACHE) II scores on ICU admission were greater in the poor outcome group than in the favorable outcome group
Body mass index (BMI) and body surface area (BSA) were higher in the favorable outcome group compared with the poor outcome group

Summary

Introduction

Nutrition is an important factor in the management of critically ill patients [1–3]. Malnutrition is associated with prolonged hospitalization and duration of mechanical ventilation, infection, and mortality in the intensive care unit (ICU) [2,4,5]. Malnutrition is associated with poor clinical outcomes in neurocritically ill patients [6–8]. Nutritional support can affect neurological prognosis as well as mortality in patients with stroke or traumatic brain injury [6–8]. Sarcopenia is characterized by the loss of skeletal muscle mass and its function [9]. Skeletal muscle mass is associated with physiologic functions [2,10,11]

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