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Araújo VA, Souza JS, Giglio BM, Lobo PCB, Pimentel GD. Association of Calf Circumference with Clinical and Biochemical Markers in Older Adults with COVID-19 Admitted at Intensive Care Unit: A Retrospective Cross-Sectional Study. Diseases 2024; 12:97. [PMID: 38785752 PMCID: PMC11119336 DOI: 10.3390/diseases12050097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND COVID-19 is an infectious disease characterized by a severe catabolic and inflammatory state, leading to loss of muscle mass. The assessment of muscle mass can be useful to identify nutritional risk and assist in early management, especially in older adults who have high nutritional risks. The aim of this study was to evaluate the association of calf circumference (CC) with clinical and biochemical markers and mortality in older adults with COVID-19 admitted to the intensive care unit (ICU). METHODS A retrospective cross-sectional study was conducted in a public hospital. CC was adjusted for body mass index (BMI), reducing 3, 7, or 12 cm for a BMI of 25-29.9, 30-39.9, and ≥40 kg/m2, respectively, and classified as reduced when <33 cm for women and <34 cm for men. Pearson's correlation between BMI and CC was performed to assess the association between variables. Regression analysis was adjusted for sex, age, and BMI variables. Cox regression was used to assess survival related to CC. RESULTS A total of 208 older adults diagnosed with COVID-19 admitted to ICU were included, of which 84% (n = 176) were classified as having reduced CC. These patients were older, with lower BMI, higher nutritional risk, malnourished, and higher concentration of urea and urea-creatinine ratio (UCR) compared with the group with normal CC. There was an association between edematous patients at nutritional risk and malnourished with reduced CC in the Cox regression, either adjusted or not for confounding. CONCLUSIONS CC was not associated with severity, biochemical markers, or mortality in older adults with COVID-19 admitted to the ICU, but it was associated with moderately malnourished patients assessed by subjective global assessment (SGA).
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Affiliation(s)
| | | | | | | | - Gustavo D. Pimentel
- Faculty of Nutrition, Federal University of Goiás, Goiânia 74605080, Brazil; (V.A.A.); (J.S.S.); (B.M.G.); (P.C.B.L.)
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Estrada-Moya F, González-Garay AG, Flores-López A, Serralde-Zúñiga AE. Total and segmental phase angle in a cohort of hospitalised patients with COVID-19: mortality prediction and changes throughout hospitalisation. Br J Nutr 2024; 131:1397-1404. [PMID: 38149452 PMCID: PMC10950452 DOI: 10.1017/s0007114523002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Body composition and phase angle (PhA) have been used to predict mortality in multiple diseases. However, little has been studied regarding segmental measurements, which could potentially help assess subtle changes in specific tissue segments. This study aimed to identify the total PhA cut-off point associated with mortality risk and changes in body composition within a week of hospitalisation in non-critical hospitalised patients with COVID-19. A cohort study was conducted where patients underwent to a complete nutritional assessment upon admission and after seven days, and followed up until hospital discharge or death. A receiver operating characteristic curve was constructed to determine the PhA cut-off point, and the Kaplan–Meier estimator was used to determine survival analysis. Segmental and complete body compositions on admission and after 7 d were compared. We included 110 patients (60 men) with a mean age of 50·5 ± 15·0 years and a median BMI of 28·5 (IQR, 25·6–33·5) kg/m2. The median length of hospital stay was 6 (IQR, 4–9) d, and the mortality rate was 13·6 %. The PhA cut-off point obtained was 4°, with significant differences in the survival rate (P < 0·001) and mortality (HR = 5·81, 95 % CI: 1·80, 18·67, P = 0·003). Segmental and whole-body compositions were negatively affected within one week of hospitalisation, with changes in the approach by the graphical method in both sexes. Nutritional status deteriorates within a week of hospitalisation. PhA < 4° is strongly associated with increased mortality in non-critical hospitalised patients with COVID-19.
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Affiliation(s)
- Fernando Estrada-Moya
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Sección de Estudios de Posgrado e Investigación, Instituto Politécnico Nacional “Escuela Superior de Medicina”, Mexico City, Mexico
| | | | - Adriana Flores-López
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aurora E. Serralde-Zúñiga
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Bernardes S, Stello BB, Milanez DSJ, Razzera EL, Silva FM. Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study. JPEN J Parenter Enteral Nutr 2024; 48:291-299. [PMID: 38142302 DOI: 10.1002/jpen.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides prognostic value superior to its unadjusted measurement for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients. METHODS In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 h of ICU admission. We adjusted calf circumference for body mass index (BMI) (25-29.9, 30-39.9, and ≥40) by subtracting 3, 7, or 12 cm from it, respectively. Values ≤34 cm for men and ≤33 cm for women identified low calf circumference. RESULTS We analyzed 325 patients. In the primary risk-adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI-adjusted) groups (hazard ratio, 0.90; 95% CI, 0.47-1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40-6.05). Every 1-cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes. CONCLUSION BMI-adjusted calf circumference did not exhibit independent associations with ICU and in-hospital death, nor with ICU and in-hospital length of stay, compared with its unadjusted measurement. However, low calf circumference (unadjusted and BMI-adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.
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Affiliation(s)
- Simone Bernardes
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Barbosa Stello
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Elisa Loch Razzera
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Wang L, Valencak TG, Shan T. Fat infiltration in skeletal muscle: Influential triggers and regulatory mechanism. iScience 2024; 27:109221. [PMID: 38433917 PMCID: PMC10907799 DOI: 10.1016/j.isci.2024.109221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Fat infiltration in skeletal muscle (also known as myosteatosis) is now recognized as a distinct disease from sarcopenia and is directly related to declining muscle capacity. Hence, understanding the origins and regulatory mechanisms of fat infiltration is vital for maintaining skeletal muscle development and improving human health. In this article, we summarized the triggering factors such as aging, metabolic diseases and metabolic syndromes, nonmetabolic diseases, and muscle injury that all induce fat infiltration in skeletal muscle. We discussed recent advances on the cellular origins of fat infiltration and found several cell types including myogenic cells and non-myogenic cells that contribute to myosteatosis. Furthermore, we reviewed the molecular regulatory mechanism, detection methods, and intervention strategies of fat infiltration in skeletal muscle. Based on the current findings, our review will provide new insight into regulating function and lipid metabolism of skeletal muscle and treating muscle-related diseases.
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Affiliation(s)
- Liyi Wang
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
| | | | - Tizhong Shan
- College of Animal Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Molecular Animal Nutrition (Zhejiang University), Ministry of Education, Hangzhou, China
- Key Laboratory of Animal Feed and Nutrition of Zhejiang Province, Hangzhou, China
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5
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Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Lugo-García DS, Astorga PCG, Melo-Villalobos A, Gonzalez-Rodriguez BK, Pérez-Calatayud ÁA. Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic. Acute Crit Care 2024; 39:47-60. [PMID: 38303585 PMCID: PMC11002617 DOI: 10.4266/acc.2023.01284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.
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Affiliation(s)
| | - Robert Alexander Jones-Baro
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Alberto Gómez-González
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Dalia Sahian Lugo-García
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | | | - Andrea Melo-Villalobos
- Department of Critical Care Rehabilitation, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
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Lakenman PLM, van Marwijk I, van der Hoven B, van Bommel J, Joosten KFM, Olieman JF. Association between fat-free mass and survival in critically ill patients with COVID-19: A prospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:192-198. [PMID: 38035857 DOI: 10.1002/jpen.2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Most critically ill patients with COVID-19 experience malnutrition and weight loss associated with negative clinical outcomes. Our primary aim was to assess body composition during acute and late phase of illness in these patients in relation to clinical outcome and secondary to tailored nutrition support. METHODS This prospective cohort study included adult critically ill patients with COVID-19. Body composition (fat-free mass [FFM] [exposure of interest], fat mass [FM], skeletal muscle mass [SMM], and phase angle [PA]) was determined with multifrequency bioelectrical impedance analyses in the acute and late phase. Nutrition support data were collected simultaneously. Clinical outcome was defined as intensive care unit (ICU) survival (primary outcome) and 30-90 days thereafter, duration of mechanical ventilation, and length of ICU stay and length of hospital stay (LOS). Nonparametric tests and regression analyses were performed. RESULTS We included 70 patients (73% male, median age 60 years). Upon admission, median BMI was 30 kg/m2 , 54% had obesity (BMI > 30 kg/m2 ). Median weight change during ICU stay was -3 kg: +3 kg FM and -6 kg FFM (-4 kg SMM). Body composition changed significantly (P < 0.001). Regarding clinical outcome, only low PA was associated with prolonged LOS (odds ratio = 0.83, 95% CI = 0.72-0.96; P = 0.015). Patients with optimal protein intake (>80%) during acute phase maintained significantly more FFM (2.7 kg, P = 0.047) in the late phase compared with patients who received <80%. CONCLUSION FFM decreased significantly during acute and late phase of illness, but we observed no association with ICU survival. Only low PA was associated with prolonged LOS. FFM wasting likely occurred because of disease severity and immobility.
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Affiliation(s)
- Patty L M Lakenman
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Iris van Marwijk
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Ben van der Hoven
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jasper van Bommel
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Joanne F Olieman
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Centre, Rotterdam, the Netherlands
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7
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Sabatino A, Pacchiarini MC, Regolisti G, Ciuni A, Sverzellati N, Lesignoli M, Picetti E, Fiaccadori E, Di Mario F. The impact of muscle mass and myosteatosis on mortality in critically ill patients with Sars-Cov2-related pneumonia. Clin Nutr ESPEN 2023; 58:409-415. [PMID: 38057033 DOI: 10.1016/j.clnesp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND & AIMS Sars-Cov-2 pneumonia can lead to severe complications, requiring invasive mechanical ventilation and admission to the intensive care unit (ICU). Low muscle quantity and quality (the latter evaluated by the amount of ectopic fat infiltration in the muscle [myosteatosis]) at ICU admission are associated with worse outcomes in critically ill patients. The purpose of the present study is to assess muscle mass and myosteatosis of paravertebral skeletal muscle, in critically ill patients with Sars-Cov2 pneumonia and its association with mortality. METHODS We conducted a retrospective observational study in 110 critically ill patients with severe Sars-Cov-2 pneumonia that had a high - resolution chest Computerized Tomography (HR-CT) at ICU admission. We acquired CT images at the level of the thoracic 12 (T12) vertebral body and measured skeletal muscle area (SMA), intermuscular adipose tissue (IMAT), and low attenuation muscle area (LAMA). Patients were followed until ICU mortality or discharge. RESULTS Patients were 59.8 ± 8.1 years old, 77% were male. Seventy-nine percent of patients were considered at nutritional risk, and 22% were obese. Average Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 17 ± 5.4, and the overall ICU mortality was 48,2% (53/110). At ICU admission, both parameters of myosteatosis were associated with higher mortality (IMAT [per 10% increase] HR: 2.01 (95% Confidence Interval [CI] 1.27 to 3.17), P = 0.003; LAMA HR [per 10% increase]: 1.53 (95% CI 1.10 to 2.13), P = 0.012). CONCLUSION Myosteatosis as assessed by CT scans plays a relevant role as a prognostic marker in critically ill patients with Sars-Cov2 severe pneumonia.
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Affiliation(s)
- Alice Sabatino
- Nephrology Unit, Parma University Hospital, Parma, Italy.
| | - Maria Chiara Pacchiarini
- Nephrology Unit, Parma University Hospital, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Regolisti
- Department of Medicine and Surgery, University of Parma, Parma, Italy; UO Clinica e Immunologia Medica, Parma University Hospital, Parma, Italy
| | - Andrea Ciuni
- Department of Radiologic Sciences, Parma University Hospital, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Department of Radiologic Sciences, Parma University Hospital, Parma, Italy
| | - Matteo Lesignoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo Picetti
- UOC Rianimazione 1, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
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8
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Jubina LE, Locke A, Fedder KR, Slone SA, Soper MK, Kalema AG, Montgomery-Yates AA, Mayer KP. Nutrition in the intensive care unit and early recovery influence functional outcomes for survivors of critical illness: A prospective cohort study. JPEN J Parenter Enteral Nutr 2023; 47:888-895. [PMID: 37345259 DOI: 10.1002/jpen.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Patients who are critically ill may receive suboptimal nutrition that leads to weight loss and increased risk of functional deficits. METHODS Our overarching hypothesis is that nutrition in the intensive care unit (ICU) and the early recovery phase associates with functional outcomes at short-term follow-up. We enrolled adult patients who attended the University of Kentucky ICU recovery clinic (ICU-RC) from November 2021 to June 2022. Patients participated in muscle and functional assessments. Nutrition intake and status during the ICU stay were analyzed. The Subjective Global Assessment and a nutrition questionnaire were used to identify changes in intake, ongoing gastrointestinal symptoms, and patient's access to food at the ICU-RC appointment. RESULTS Forty-one patients enrolled with a median hospital length of stay (LOS) of 23 days. Patients with 0 days of nil per os (NPO) status throughout hospitalization had a shorter LOS (P = 0.05), were able to complete the five times sit-to-stand test (P = 0.02), and were less likely to experience ICU-acquired weakness (P = 0.04) at short-term follow-up compared with patients with ≥1 day of NPO status. Twenty (48%) patients reported changes in nutrition intake in early recovery compared with before hospitalization. Eight (20%) patients reported symptoms leading to decreased intake and four (10%) reported access to food as a barrier to intake. CONCLUSION Barriers to nutrition exist during critical illness and persist after discharge, with almost half of patients reporting a change in intake. Inpatient nutrition intake is associated with functional outcomes and warrants further exploration.
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Affiliation(s)
- Lindsey E Jubina
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Alleyna Locke
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly R Fedder
- Department of Clinical Nutrition, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Stacey A Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Melissa K Soper
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, Internal Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Research Alliance for Lung Disease, Office of Research, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Sumbal R, Sumbal A, Ali Baig MM. Which vertebral level should be used to calculate sarcopenia in covid-19 patients? A systematic review and meta-analysis. Clin Nutr ESPEN 2023; 56:1-8. [PMID: 37344057 DOI: 10.1016/j.clnesp.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/15/2023] [Accepted: 04/25/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND & AIMS Evidence shows that CT-derived sarcopenia can predict adverse outcomes in COVID-19 patients. However, discrepancies exist as to which vertebral level can be used to calculate sarcopenia which can effectively serve as a prognostic tool. Thus, we aim to investigate the difference in sarcopenia calculated at the Thoracic and Lumbar vertebral levels. METHODS An online literature search was conducted on Electronic databases such as PubMed, Cochrane CENTRAL, and Google scholar. Meta-analysis was performed by using Revman 5.3 software. RESULTS A total of 14 articles were selected for meta-analysis. The prevalence of sarcopenia calculated at the Thoracic level was 31% (95%CI 24%-37%; p < 0.00001; I2 = 86%), while sarcopenia calculated at the Lumbar vertebral level was 63% (95%CI 51%-75%; p < 0.00001; I2 = 88%). Meanwhile, sarcopenia calculated at the Upper thoracic level was a significant predictor of mortality OR 3.47 (95%CI 1.74-6.91; p = 0.0004; I2 = 56%)as compared to sarcopenia calculated at the lower thoracic OR 1.74 (95%Cl 0.91-3.33; p = 0.10; I2 = 60%)or lumbar level OR 2.49 (95%CI 0.45-13.72; p = 0.30; I2 = 57%). In addition to this sarcopenia calculated at the Upper thoracic level was also a significant predictor of severe illness OR 3.92 (95%CI 2.33-6.58; p < 0.00001; I2 = 0%) as compared to lower thoracic OR 1.40 (95%CI 0.78-2.53; p = 0.26; I2 = 67%) or lumbar level OR 1.64 (95%CI 0.26-10.50; p = 0.60; I2 = 81%) CONCLUSIONS: Sarcopenia calculated at the thoracic vertebrae and lumber level has different prognostic values. Sarcopenia is prevalent at the lumbar level. Sarcopenia at the thoracic level has a higher mortality and severity rate.
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Affiliation(s)
- Ramish Sumbal
- Dow University of Health and Science, Baba-E-Urdu Road, 74200, Karachi, Pakistan.
| | - Anusha Sumbal
- Dow University of Health and Science, Baba-E-Urdu Road, 74200, Karachi, Pakistan
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10
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Santer D, Schneider N, de Carvalho YSS, de Souza Bortolini RV, Silva FM, Franken DL, da Silva Fink J. The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients. Clin Nutr ESPEN 2023; 54:45-51. [PMID: 36963893 PMCID: PMC9831974 DOI: 10.1016/j.clnesp.2023.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. METHODS This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of ≤33 cm for women and ≤34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. RESULTS A total of 249 patients were included (53.4% men, 62.2 ± 13.9 years of age, SOFA severity score 9.6 ± 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63; 95% CI 1.65-4.18) or reduced MAC (HR = 2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. CONCLUSION Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.
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Affiliation(s)
- Danieli Santer
- Grupo Hospitalar Conceição, Multiprofessional Residency in Health, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nicole Schneider
- Grupo Hospitalar Conceição, Multiprofessional Residency in Health, Porto Alegre, Rio Grande do Sul, Brazil
| | - Yasmim Sena Silva de Carvalho
- Grupo Hospitalar Conceição, Division of Nutrition and Dietetics of Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renata Vieira de Souza Bortolini
- Grupo Hospitalar Conceição, Division of Nutrition and Dietetics of Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Graduate Program of Nutrition Science at Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brazil
| | - Débora Luiza Franken
- Grupo Hospitalar Conceição, Division of Nutrition and Dietetics of Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jaqueline da Silva Fink
- Grupo Hospitalar Conceição, Division of Nutrition and Dietetics of Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil.
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11
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Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19. NUTR HOSP 2023; 40:250-256. [PMID: 36880718 DOI: 10.20960/nh.04553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. METHODS this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. RESULTS eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). CONCLUSION FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.
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Grigioni S, Lvovschi VE, Tamion F, Joly LM, Coëffier M, Van Elslande H, Galmiche M, Gâté M, Traore-Ouattara U, Marais B, Michel J, Dechelotte P, Savoye-Collet C, Achamrah N. Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19. Clin Nutr 2023; 42:102-107. [PMID: 36521254 PMCID: PMC9674398 DOI: 10.1016/j.clnu.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. METHODS Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. RESULTS We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6 kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR = 1,88 [1,06-2,98]) and increased length of stay (OR = 1,87 [1,14-3,49]) but not with mortality (OR = 1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR = 5,56 [1,96-16,67]. CONCLUSION Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.
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Affiliation(s)
- S Grigioni
- Nutrition Department, CHU Rouen, Rouen, France; Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Clinical Investigation Centre CIC 1404, INSERM and CHU Rouen, France
| | - V-E Lvovschi
- Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Emergency Department, CHU Rouen, Rouen, France
| | - F Tamion
- Medical Intensive Care Unit, CHU Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, F-76000 Rouen, France
| | - L-M Joly
- Emergency Department, CHU Rouen, Rouen, France
| | - M Coëffier
- Nutrition Department, CHU Rouen, Rouen, France; Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Clinical Investigation Centre CIC 1404, INSERM and CHU Rouen, France
| | - H Van Elslande
- Nutrition Department, CHU Rouen, Rouen, France; Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Clinical Investigation Centre CIC 1404, INSERM and CHU Rouen, France
| | | | - M Gâté
- Nutrition Department, CHU Rouen, Rouen, France
| | | | - B Marais
- Medical Intensive Care Unit, CHU Rouen, France
| | - J Michel
- Emergency Department, CHU Rouen, Rouen, France
| | - P Dechelotte
- Nutrition Department, CHU Rouen, Rouen, France; Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Clinical Investigation Centre CIC 1404, INSERM and CHU Rouen, France
| | | | - N Achamrah
- Nutrition Department, CHU Rouen, Rouen, France; Normandie Univ, UNIROUEN, INSERM UMR 1073, Nutrition, Inflammation et axe microbiote-intestin-cerveau, IRIB, Rouen, France; Clinical Investigation Centre CIC 1404, INSERM and CHU Rouen, France.
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13
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Wang Y, Tan S, Yan Q, Gao Y. Sarcopenia and COVID-19 Outcomes. Clin Interv Aging 2023; 18:359-373. [PMID: 36923269 PMCID: PMC10010141 DOI: 10.2147/cia.s398386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) spread rapidly and became a severe global public health threat. Older adults have a high risk of COVID-19 and its associated mortality. Sarcopenia has emerged as a predictor of poor outcomes in COVID-19 patients, including lengthy hospital stays, mortality, intensive care unit admission, need for invasive mechanical ventilation, and poor rehabilitation outcomes. Chronic inflammation, immune dysfunction, respiratory muscle dysfunction, and swallowing dysfunction may underlie the association between sarcopenia and the poor outcomes of COVID-19 patients. Interleukin 6 receptor blockers (tocilizumab or sarilumab) are recommended for treating patients with severe COVID-19, and their therapeutic effects on sarcopenia are of great interest. This review aimed to analyze the current reports on the association between sarcopenia and COVID-19 and provide an update on the contribution of sarcopenia to the severity and adverse outcomes of COVID-19 and its underlying mechanisms. We also aimed to explore the different screening tools for sarcopenia concurrent with COVID-19, and advocate for early diagnosis and treatment of sarcopenia. Given that the fight against the COVID-19 pandemic may be long-term, further research into understanding the effects of sarcopenia in patients infected with the Omicron variant is necessary.
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Affiliation(s)
- Yuhan Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Shuwen Tan
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Qihui Yan
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Ying Gao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, People's Republic of China
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14
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Piotrowicz K, Ryś M, Perera I, Gryglewska B, Fedyk-Łukasik M, Michel JP, Wizner B, Sydor W, Olszanecka A, Grodzicki T, Gąsowski J. Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment. BMC Geriatr 2022; 22:941. [PMID: 36476473 PMCID: PMC9727948 DOI: 10.1186/s12877-022-03571-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures. METHODS The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay. RESULTS The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death. CONCLUSIONS In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.
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Affiliation(s)
- Karolina Piotrowicz
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Monika Ryś
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Ian Perera
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Barbara Gryglewska
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Małgorzata Fedyk-Łukasik
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | | | - Barbara Wizner
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Wojciech Sydor
- grid.412700.00000 0001 1216 0093Center for Innovative Therapies, Clinical Research Coordination Center, University Hospital in Kraków, Kraków, Poland ,grid.5522.00000 0001 2162 9631Department of Rheumatology and Immunology, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- grid.5522.00000 0001 2162 9631Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland
| | - Jerzy Gąsowski
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland ,grid.412700.00000 0001 1216 0093Department of Internal Medicine and Geriatrics, University Hospital in Kraków, Kraków, Poland ,grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, University Hospital, 2 Jakubowskiego St., building I, 5th floor, 30-688 Kraków, Poland
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Prognostic Impact of Myosteatosis on Mortality in Hospitalized Patients with COVID-19. Diagnostics (Basel) 2022; 12:diagnostics12092255. [PMID: 36140656 PMCID: PMC9497568 DOI: 10.3390/diagnostics12092255] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/08/2023] Open
Abstract
Body composition, including sarcopenia, adipose tissue, and myosteatosis, is associated with unfavorable clinical outcomes in patients with coronavirus disease (COVID-19). However, few studies have identified the impact of body composition, including pre-existing risk factors, on COVID-19 mortality. Therefore, this study aimed to evaluate the effect of body composition, including pre-existing risk factors, on mortality in hospitalized patients with COVID-19. This two-center retrospective study included 127 hospitalized patients with COVID-19 who underwent unenhanced chest computed tomography (CT) between February and April 2020. Using the cross-sectional CT images at the L2 vertebra level, we analyzed the body composition, including skeletal muscle mass, visceral to subcutaneous adipose tissue ratio (VSR), and muscle density using the Hounsfield unit (HU). Of 127 patients with COVID-19, 16 (12.6%) died. Compared with survivors, non-survivors had low muscle density (41.9 vs. 32.2 HU, p < 0.001) and high proportion of myosteatosis (4.5 vs. 62.5%, p < 0.001). Cox regression analyses revealed diabetes (hazard ratio [HR], 3.587), myosteatosis (HR, 3.667), and a high fibrosis-4 index (HR, 1.213) as significant risk factors for mortality in patients with COVID-19. Myosteatosis was associated with mortality in hospitalized patients with COVID-19, independent of pre-existing prognostic factors.
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Xu Y, Xu JW, You P, Wang BL, Liu C, Chien CW, Tung TH. Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Nutr 2022; 9:925606. [PMID: 35859753 PMCID: PMC9289534 DOI: 10.3389/fnut.2022.925606] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background It has been speculated that patients with sarcopenia are aggravated by the current novel coronavirus disease 2019 (COVID-19) epidemic. However, there is substantial uncertainty regarding the prevalence of sarcopenia in patients with COVID-19. Objectives The purpose of the study was to systematically evaluate the prevalence of sarcopenia in patients with COVID-19, including stratification by gender, study location, study population, study design, and diagnostic criteria. Design This is the systematic literature review and meta-analysis. Methods An electronic search was performed in MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science and Scopus to identify observational studies reporting a prevalence estimate for sarcopenia in patients with COVID-19. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Risk of bias (RoB) was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) manual for cross-sectional studies, and Stata 14.0 was used to perform meta-analyses. Results A total of 4,639 studies were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 151 full-text studies. A total of 21 studies, including 5,407 patients, were eligible for inclusion in this review finally. The prevalence of sarcopenia in patients with COVID-19 in individual studies varied from 0.8 to 90.2%. The pooled prevalence of sarcopenia in COVID-19 was 48.0% (95% confidence interval, CI: 30.8 to 65.1%, I2 = 99.68%, p = 0.000). We did not find any significant differences in the prevalence estimates between gender specificity (OR = 1.34; 95% CI = 0.80–2.26; p = 0.001). By sex, the prevalence was 42.5% (95% CI: 31.7 to 53.4%) in men and 35.7% (95% CI: 24.2 to 47.2%) in women. The prevalence estimates significantly varied based on population settings and different diagnostic criteria of sarcopenia. ICU patients (69.7, 95% CI: 51.7 to 85.2%) were more likely to suffer from sarcopenia compared to other population settings. Conclusion To our knowledge, this is the first meta-analysis reporting on the prevalence of sarcopenia in patients with COVID-19. Sarcopenia is frequently observed in patients with COVID-19, with varying prevalence across population settings. This study would be useful for clinicians to prompt the increasing awareness of identifying sarcopenia and developing interventions at patients with COVID-19 with high risk of sarcopenia. Further prospective longitudinal studies to define the association of sarcopenia and its prognostic outcomes in COVID-19 survivors are urgently needed to propose the most appropriate treatment strategies during their admission and discharge. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022300431].
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Affiliation(s)
- Ying Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
- Evidence-Based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Jia-wen Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Peng You
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Bing-Long Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Liu
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen, China
- *Correspondence: Ching-Wen Chien,
| | - Tao-Hsin Tung
- Evidence-Based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- Tao-Hsin Tung,
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Li X, Lang X, Peng S, Ding L, Li S, Li Y, Yin L, Liu X. Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches. J Nutr Health Aging 2022; 26:826-838. [PMID: 36156674 DOI: 10.1007/s12603-022-1838-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC. METHODS We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses. RESULTS Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool. CONCLUSIONS Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.
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Affiliation(s)
- X Li
- Lu Yin, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 102300, China. E-mail: ; Xiaomei Liu, Department of Emergency, Zhongshan Hospital of Xiamen University, Xiamen, China. Tel:
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