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Master Thesis

Early trauma-induced sarcopenia diagnosed on psoas CT scan predicts a prolonged mechanical ventilation duration and a worse outcome in severe trauma patients

Abstract : The aim of present study was to assess the association between early Trauma-Induced Sarcopenia (TIS) determined on psoas CT scan and mechanical ventilation duration and outcomes in severe trauma patients. Methods: a retrospective analysis of severe trauma patients (ISS >15) hospitalized in intensive care unit (ICU) longer than 7 days between January 2010 and December 2015 was performed. Psoas muscle index (PMI) was measured on both admission and delayed CT scan. ΔPMI was then calculated as the percentage of PMI loss between these two scans. Three groups were a posteriori defined using the quartiles of ΔPMI value and compared: low (lower quart), moderate, and severe (higher quart) early TIS groups. Linear regression analysis was also performed to predict mechanical ventilation duration, catecholamines duration, ICU and hospital length of stay (LOS), and complications was assessed. Results: a total of 114 trauma patients were included (age 40 years [IQR, 25–54], ISS 33 [IQR, 25–41]). Based on the ΔPMI determination, 29 patients were allocated in the Low early TIS group (range ΔPMI 0–6.4%), 56 in the Moderate early TIS group (range ΔPMI 6.5–18.2%), and 29 in the Severe early TIS group (range ΔPMI ≥18.8%). Severity of early TIS was significantly associated with mechanical ventilation and catecholamines durations, ICU and hospital LOS (P<0.001). Delayed pneumonia (P=0.006) and other delayed infections (P=0.014), as well as thromboembolic events (P=0.04) were statistically associated with the severity of early TIS, whereas mortality did not differ between 3 groups (P=0.20). Using linear regression analysis, each ΔPMI increasing of 1% was significantly associated with 0.90 supplementary days of mechanical ventilation (P<0.001), 0.29 supplementary days of catecholamines (P<0.001) and 0.82 supplementary days of hospitalisation (P<0.001). All these statistical associations were confirmed in multivariate analysis (P<0.001). Conclusion: early TIS diagnosed on CT scan by psoas measurement was strongly associated with poor outcomes in severe trauma patients.
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Master Thesis
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Submitted on : Wednesday, June 2, 2021 - 11:39:12 AM
Last modification on : Monday, October 11, 2021 - 1:25:04 PM
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Sonia Tazerout. Early trauma-induced sarcopenia diagnosed on psoas CT scan predicts a prolonged mechanical ventilation duration and a worse outcome in severe trauma patients. Human health and pathology. 2018. ⟨dumas-03246212⟩

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