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Fischer A, Hertwig A, Hahn R, Anwar M, Siebenrock T, Pesta M, Liebau K, Timmermann I, Brugger J, Posch M, Ringl H, Tamandl D, Hiesmayr M, Roth D, Zielinski C, Jäger U, Staudinger T, Schellongowski P, Lang I, Gottsauner-Wolf M, Mascherbauer J, Heinz G, Oberbauer R, Trauner M, Ferlitsch A, Zauner C, Wolf Husslein P, Krepler P, Shariat S, Gnant M, Sahora K, Laufer G, Taghavi S, Huk I, Radtke C, Markstaller K, Rössler B, Schaden E, Bacher A, Faybik P, Ullrich R, Plöchl W, Ihra G, Schäfer B, Mouhieddine M, Neugebauer T, Mares P, Steinlechner B, Schiferer A, Tschernko E. Validation of bedside ultrasound to predict lumbar muscle area in the computed tomography in 200 non-critically ill patients: The USVALID prospective study. Clin Nutr 2022; 41:829-837. [PMID: 35263692 DOI: 10.1016/j.clnu.2022.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Skeletal muscle area (SMA) in the computed tomography (CT) at the third lumbar vertebra (L3) level is a proxy for whole-body muscle mass but is only performed for clinical reasons. Ultrasound is a promising tool to determine muscle mass at the bedside. It is still unclear how well ultrasound and which ultrasound measuring points can predict CT L3 SMA. METHODS This prospective observational trial included 200 non-critically ill patients, who underwent an abdominal CT scan for any clinical reason within 48 h before the ultrasound examination. Ultrasound muscle thickness was evaluated at 3 measuring points on the thigh and 2 measuring points on the upper arm with minimal compression. On the CT scan, the entire L3 SMA was measured based on Hounsfield units. Using a model selection algorithm based on the Bayesian information criterion (BIC) and clinical considerations, a linear prediction model for CT L3 SMA based on the ultrasound muscle thickness and other independent variables was fitted and assessed with cross-validation. RESULTS 67,5% and 32,5% of the patients were from surgical and medical wards, respectively. Mean ultrasound muscle thickness values were between 2,2 and 3,6 cm on the thigh and between 1,4 and 2,8 cm on the upper arm. All ultrasound muscle thickness values were higher in men than in women (P < 0,05). CT L3 SMA was 40 cm2 higher in men than in women (P < 0,001). The final prediction model for CT L3 SMA included the following 4 independent variables: ultrasound muscle thickness at the ventral measuring point of the thigh in the short-axis plane, sex, weight, and height. It had a similar BIC (BIC of 1515) compared to larger models with 6-8 independent variables including multiple ultrasound measuring points (BIC of 1506-1519). Additional clinical considerations to choose the final model were less time consumption when measuring a single ultrasound measuring point and better anatomical overview at the short-axis plane. The final model predicted CT L3 SMA with a R2 of 0,74 (P < 0,001) and a cross-validated R2 of 0,65. CONCLUSIONS One single ultrasound measuring point at the thigh together with sex, height and weight very well predicts CT L3 SMA across different clinical populations. Ultrasound is a safe and bedside method to measure muscle thickness longitudinally to monitor the effects of nutrition and physical therapy.
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Affiliation(s)
- Arabella Fischer
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Anatol Hertwig
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Ricarda Hahn
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Martin Anwar
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Timo Siebenrock
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Maximilian Pesta
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Konstantin Liebau
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Isabel Timmermann
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria
| | - Helmut Ringl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Michael Hiesmayr
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria.
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Fischer A, Siebenrock T, Liebau K, Hertwig A, Hahn R, Anwar M, Pesta M, Timmermann I, Brugger J, Posch M, Tamandl D, Ringl H, Hiesmayr M. Association of ct skeletal muscle area and density with age: a prospective study in 200 non-critically ill patients. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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