Abstract
Aim Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. Methods Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. Results In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. Conclusions For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.
Highlights
Acute pulmonary embolism presents on a spectrum of severity with the most severe presentations carrying a substantial risk of morbidity and mortality
There was no significant difference between the pulmonary embolism patients with or without in-hospital mortality with regard to the age and gender of patients
To examine the role of clinical factors producing significant difference in the in-hospital mortality rate of patients with pulmonary embolism with logistic regression analysis (Table 2), the results showed that only the value of psoas muscle area significantly reduced the rate of in-hospital mortality with an odds ratio of 0.259 (p < 0:05)
Summary
Acute pulmonary embolism presents on a spectrum of severity with the most severe presentations carrying a substantial risk of morbidity and mortality. Risk management poses a significant challenge when facing complex decisions regarding potential use of invasive procedures in older patients in the management of pulmonary embolism [1,2,3,4]. The cornerstone of appropriate management in patients with pulmonary embolism in the intensive care unit is early detection of mortality risk. For this purpose, the applications of several tools are used at admission and during followup.
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