Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study
Background Lower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical fun...
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description | Background Lower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function. Methods In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU). Results Sixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge. Conclusions Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) Trial registration UMIN 000031316. Retrospectively registered on 15 February 2018. |
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Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function. Methods In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU). Results Sixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge. Conclusions Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) Trial registration UMIN 000031316. Retrospectively registered on 15 February 2018.</description><identifier>ISSN: 2052-0492</identifier><identifier>EISSN: 2052-0492</identifier><identifier>DOI: 10.1186/s40560-020-00507-7</identifier><identifier>PMID: 33292655</identifier><language>eng</language><publisher>London: BioMed Central</publisher><subject>Atrophy ; Calories ; Enteral nutrition ; Hospitals ; Intensive care ; Mortality ; Nutrition ; Observational studies ; Parenteral nutrition ; Physical therapists ; Proteins ; Sepsis ; Ultrasonic imaging ; Ventilators</subject><ispartof>Journal of intensive care, 2020-11, Vol.8 (1), p.1-87, Article 87</ispartof><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c497t-95b4f1994686db15480dae8cb5f8988c9718d28d8b7f86c7495403bad15a410a3</citedby><cites>FETCH-LOGICAL-c497t-95b4f1994686db15480dae8cb5f8988c9718d28d8b7f86c7495403bad15a410a3</cites><orcidid>0000-0003-3824-0977 ; 0000-0002-2394-2688</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684934/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684934/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Nakanishi, Nobuto</creatorcontrib><creatorcontrib>Oto, Jun</creatorcontrib><creatorcontrib>Tsutsumi, Rie</creatorcontrib><creatorcontrib>Akimoto, Yusuke</creatorcontrib><creatorcontrib>Nakano, Yuki</creatorcontrib><creatorcontrib>Nishimura, Masaji</creatorcontrib><title>Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study</title><title>Journal of intensive care</title><description>Background Lower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function. Methods In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU). Results Sixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge. Conclusions Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) Trial registration UMIN 000031316. Retrospectively registered on 15 February 2018.</description><subject>Atrophy</subject><subject>Calories</subject><subject>Enteral nutrition</subject><subject>Hospitals</subject><subject>Intensive care</subject><subject>Mortality</subject><subject>Nutrition</subject><subject>Observational studies</subject><subject>Parenteral nutrition</subject><subject>Physical therapists</subject><subject>Proteins</subject><subject>Sepsis</subject><subject>Ultrasonic imaging</subject><subject>Ventilators</subject><issn>2052-0492</issn><issn>2052-0492</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdks-O1SAUxhujcSbjvIArEjduqkChgAsTM_FfMokbZ00oUMuElgr0Tu7b-Wiezr0xKgmBHH5854N8TfOS4DeEyP5tYZj3uMUUJuZYtOJJc0kxpy1mij79a3_RXJdyjzEmmHe9VM-bi66jivacXza_7tbVZxTDPKB5KzZ6ZGpO63REppRkg6neoYdQJxSWdkplDdVENKcMS6hALQ4BXYKF8rgttoa0oDCvJuTZL7XAPTR7O5llR-IRHaAa4qOuzaGeqyFGZNwWa3mHDKoPqbXAgbU1Q1MPsgeP0lB8Ppi9BXQrdXPHF82z0cTir8_rVXP36eP3my_t7bfPX28-3LaWKVFbxQc2EqVYL3s3EM4kdsZLO_BRKimtEkQ6Kp0cxCh7K5jiDHeDcYQbRrDprpr3J911G2bvdnPZRL3mMJt81MkE_e_JEib9Ix206CVTHQOB12eBnH5uvlQ9h2J9jGbxaSua7tZ6AQPQV_-h92nL8OSdEoQIwrgEip4oCz9Ush__mCFY7xnRp4xoyIh-zIgW3W9IALRA</recordid><startdate>20201123</startdate><enddate>20201123</enddate><creator>Nakanishi, Nobuto</creator><creator>Oto, Jun</creator><creator>Tsutsumi, Rie</creator><creator>Akimoto, Yusuke</creator><creator>Nakano, Yuki</creator><creator>Nishimura, Masaji</creator><general>BioMed Central</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3824-0977</orcidid><orcidid>https://orcid.org/0000-0002-2394-2688</orcidid></search><sort><creationdate>20201123</creationdate><title>Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study</title><author>Nakanishi, Nobuto ; Oto, Jun ; Tsutsumi, Rie ; Akimoto, Yusuke ; Nakano, Yuki ; Nishimura, Masaji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c497t-95b4f1994686db15480dae8cb5f8988c9718d28d8b7f86c7495403bad15a410a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Atrophy</topic><topic>Calories</topic><topic>Enteral nutrition</topic><topic>Hospitals</topic><topic>Intensive care</topic><topic>Mortality</topic><topic>Nutrition</topic><topic>Observational studies</topic><topic>Parenteral nutrition</topic><topic>Physical therapists</topic><topic>Proteins</topic><topic>Sepsis</topic><topic>Ultrasonic imaging</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakanishi, Nobuto</creatorcontrib><creatorcontrib>Oto, Jun</creatorcontrib><creatorcontrib>Tsutsumi, Rie</creatorcontrib><creatorcontrib>Akimoto, Yusuke</creatorcontrib><creatorcontrib>Nakano, Yuki</creatorcontrib><creatorcontrib>Nishimura, Masaji</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of intensive care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakanishi, Nobuto</au><au>Oto, Jun</au><au>Tsutsumi, Rie</au><au>Akimoto, Yusuke</au><au>Nakano, Yuki</au><au>Nishimura, Masaji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study</atitle><jtitle>Journal of intensive care</jtitle><date>2020-11-23</date><risdate>2020</risdate><volume>8</volume><issue>1</issue><spage>1</spage><epage>87</epage><pages>1-87</pages><artnum>87</artnum><issn>2052-0492</issn><eissn>2052-0492</eissn><abstract>Background Lower limb muscle atrophy is often observed in critically ill patients. Although upper limb muscles can undergo atrophy, it remains unclear how this atrophy is associated with clinical outcomes. We hypothesized that this atrophy is associated with mortality and impairments in physical function. Methods In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU). Results Sixty-four patients (43 males; aged 70 ± 13 years) were enrolled. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 27 (22–30), and in-hospital mortality occurred in 21 (33%) patients. The decreased cross-sectional area of the biceps brachii was not associated with in-hospital mortality on day 3 (p = 0.43) but was associated on days 5 (p = 0.01) and 7 (p < 0.01), which was confirmed after adjusting for sex, age, and APACHE II score. In 27 patients in whom physical functions were assessed, the decrease of the cross-sectional area of the biceps brachii was associated with MRC score (r = 0.47, p = 0.01), handgrip strength (r = 0.50, p = 0.01), and FSS-ICU (r = 0.56, p < 0.01), but not with IMS score (r = 0.35, p = 0.07) upon ICU discharge. Conclusions Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) Trial registration UMIN 000031316. Retrospectively registered on 15 February 2018.</abstract><cop>London</cop><pub>BioMed Central</pub><pmid>33292655</pmid><doi>10.1186/s40560-020-00507-7</doi><orcidid>https://orcid.org/0000-0003-3824-0977</orcidid><orcidid>https://orcid.org/0000-0002-2394-2688</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Atrophy Calories Enteral nutrition Hospitals Intensive care Mortality Nutrition Observational studies Parenteral nutrition Physical therapists Proteins Sepsis Ultrasonic imaging Ventilators |
title | Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study |
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