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Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study

Background & aims: In critically ill patients, direct measurement of skeletal muscle using bedside ul-trasound (US) may identify a patient population that might benefit more from optimal nutrition prac-tices. When US is not available, survey measures of nutrition risk and functional status that...

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Main Authors: Lee, Zheng-Yii, Ong, Su Ping, Ng, Ching Choe, Yap, Cindy Sing Ling, Engkasan, Julia Patrick, Barakatun-Nisak, Mohd Yusof, Heyland, Daren K., Hasan, Mohd Shahnaz
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Published: Churchill Livingstone 2021
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QP Physiology
RA0421 Public health. Hygiene. Preventive Medicine
Online Access:http://eprints.um.edu.my/33948/
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spelling my.um.eprints.339482022-07-08T03:03:36Z http://eprints.um.edu.my/33948/ Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study Lee, Zheng-Yii Ong, Su Ping Ng, Ching Choe Yap, Cindy Sing Ling Engkasan, Julia Patrick Barakatun-Nisak, Mohd Yusof Heyland, Daren K. Hasan, Mohd Shahnaz QP Physiology RA0421 Public health. Hygiene. Preventive Medicine Background & aims: In critically ill patients, direct measurement of skeletal muscle using bedside ul-trasound (US) may identify a patient population that might benefit more from optimal nutrition prac-tices. When US is not available, survey measures of nutrition risk and functional status that are associated with muscle status may be used to identify patients with low muscularity. This study aims to determine the association between baseline and changing ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality. Methods: This single-center prospective observational study was conducted in a general ICU. Mechani-cally ventilated critically ill adult patients (age >18 years) without pre-existing systemic neuromuscular diseases and expected to stay for >96 h in the ICU were included. US measurements were performed within 48 h of ICU admission (baseline), at day 7, day 14 of ICU stay and at ICU discharge (if stay >14 days). Quadriceps muscle layer thickness (QMLT), rectus femoris cross sectional area (RFCSA), vastus intermedius pennation angle (PA) and fascicle length (FL), and rectus femoris echogenicity (mean and standard deviation SD]) were measured. Patients' next-of-kin were interviewed by using established questionnaires for their pre-hospitalization nutritional risk (nutrition risk screening-2002) and func-tional status (SARC-F, clinical frailty scale CFS], Katz activities of daily living ADL] and Lawton Instru-mental ADL). Results: Ninety patients were recruited. A total of 86, 53, 24 and 10 US measures were analyzed, which were performed ata median of 1, 7,14 and 22 days from ICU admission, respectively. QMLT, RFCSA and PA reduced significantly over time. The overall trend of change of FL was not significant. The only inde-pendent predictor of 60-day mortality was the change of QMLT from baseline to day 7 (adjusted odds ratio 0.95 for every 1% less QMLT loss, 95% confidence interval 0.91-0.99; p = 0.02). Baseline measures of high nutrition risk (modified nutrition risk in critically ill >5), sarcopenia (SARC-F >4) and frailty (CFS >5) were associated with lower baseline QMLT, RFCSA and PA and higher 60-day mortality. Conclusions: Every 1% loss of QMLT over the first week of critical illness was associated with 5% higher odds of 60-day mortality. SARC-F, CFS and mNUTRIC are associated with quadriceps muscle status and 60-day mortality and may serve as a potential simple and indirect measures of premorbid muscle status at ICU admission. (c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. Churchill Livingstone 2021-03 Article PeerReviewed Lee, Zheng-Yii and Ong, Su Ping and Ng, Ching Choe and Yap, Cindy Sing Ling and Engkasan, Julia Patrick and Barakatun-Nisak, Mohd Yusof and Heyland, Daren K. and Hasan, Mohd Shahnaz (2021) Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study. Clinical Nutrition, 40 (3). pp. 1338-1347. ISSN 0261-5614, DOI https://doi.org/10.1016/j.clnu.2020.08.022 <https://doi.org/10.1016/j.clnu.2020.08.022>. 10.1016/j.clnu.2020.08.022
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic QP Physiology
RA0421 Public health. Hygiene. Preventive Medicine
spellingShingle QP Physiology
RA0421 Public health. Hygiene. Preventive Medicine
Lee, Zheng-Yii
Ong, Su Ping
Ng, Ching Choe
Yap, Cindy Sing Ling
Engkasan, Julia Patrick
Barakatun-Nisak, Mohd Yusof
Heyland, Daren K.
Hasan, Mohd Shahnaz
Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
description Background & aims: In critically ill patients, direct measurement of skeletal muscle using bedside ul-trasound (US) may identify a patient population that might benefit more from optimal nutrition prac-tices. When US is not available, survey measures of nutrition risk and functional status that are associated with muscle status may be used to identify patients with low muscularity. This study aims to determine the association between baseline and changing ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality. Methods: This single-center prospective observational study was conducted in a general ICU. Mechani-cally ventilated critically ill adult patients (age >18 years) without pre-existing systemic neuromuscular diseases and expected to stay for >96 h in the ICU were included. US measurements were performed within 48 h of ICU admission (baseline), at day 7, day 14 of ICU stay and at ICU discharge (if stay >14 days). Quadriceps muscle layer thickness (QMLT), rectus femoris cross sectional area (RFCSA), vastus intermedius pennation angle (PA) and fascicle length (FL), and rectus femoris echogenicity (mean and standard deviation SD]) were measured. Patients' next-of-kin were interviewed by using established questionnaires for their pre-hospitalization nutritional risk (nutrition risk screening-2002) and func-tional status (SARC-F, clinical frailty scale CFS], Katz activities of daily living ADL] and Lawton Instru-mental ADL). Results: Ninety patients were recruited. A total of 86, 53, 24 and 10 US measures were analyzed, which were performed ata median of 1, 7,14 and 22 days from ICU admission, respectively. QMLT, RFCSA and PA reduced significantly over time. The overall trend of change of FL was not significant. The only inde-pendent predictor of 60-day mortality was the change of QMLT from baseline to day 7 (adjusted odds ratio 0.95 for every 1% less QMLT loss, 95% confidence interval 0.91-0.99; p = 0.02). Baseline measures of high nutrition risk (modified nutrition risk in critically ill >5), sarcopenia (SARC-F >4) and frailty (CFS >5) were associated with lower baseline QMLT, RFCSA and PA and higher 60-day mortality. Conclusions: Every 1% loss of QMLT over the first week of critical illness was associated with 5% higher odds of 60-day mortality. SARC-F, CFS and mNUTRIC are associated with quadriceps muscle status and 60-day mortality and may serve as a potential simple and indirect measures of premorbid muscle status at ICU admission. (c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
format Article
author Lee, Zheng-Yii
Ong, Su Ping
Ng, Ching Choe
Yap, Cindy Sing Ling
Engkasan, Julia Patrick
Barakatun-Nisak, Mohd Yusof
Heyland, Daren K.
Hasan, Mohd Shahnaz
author_facet Lee, Zheng-Yii
Ong, Su Ping
Ng, Ching Choe
Yap, Cindy Sing Ling
Engkasan, Julia Patrick
Barakatun-Nisak, Mohd Yusof
Heyland, Daren K.
Hasan, Mohd Shahnaz
author_sort Lee, Zheng-Yii
title Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
title_short Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
title_full Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
title_fullStr Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
title_full_unstemmed Association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: A single-center prospective observational study
title_sort association between ultrasound quadriceps muscle status with premorbid functional status and 60-day mortality in mechanically ventilated critically ill patient: a single-center prospective observational study
publisher Churchill Livingstone
publishDate 2021
url http://eprints.um.edu.my/33948/
_version_ 1738510694519668736
score 13.211869

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