[Lumbar muscle density as a prognostic marker of nutritional deficiency in patients with pancreatic necrosis complicated by external duodenal fistulas: a pilot study].

Abstract

Objective. t: O assess severity of catabolism in patients with pancreatic necrosis complicated by external duodenal fistulas considering CT data of lumbar muscle density.

Material and methods: A retrospective non-randomized pilot study included 11 patients (7 men (63.6%) and 4 women (36.4%)) diagnosed with severe acute pancreatitis and pancreatic necrosis. Late phase of disease was complicated by external duodenal fistulas in all patients. Mean age of patients ranged from 34 to 88 years (49 (34; 88) years). All patients were retrospectively assessed for lumbar muscle density at the level of the third lumbar vertebra using CT data (HUAC). Study stages: stage 1 - 24 hours after admission; stage 2 - 1.5±0.52 days after external duodenal fistula; stage 3 - 19.4±6.68 days after external duodenal fistula. The following parameters were retrospectively assessed in all patients: RPHU, RPA, LPHU, LPA. After that, mean lumbar muscle density (HUAC) was calculated. To assess prognostic significance of parameters, patients were divided depending on outcomes: group of survivors included 8 patients (n=8; 72.7%) aged 34-62 years; group of deceased included 3 patients (n=3; 27.3%) aged 63-88 years.

Results: At the first stage (HUAC 1), values were was 34.69±8.44 (95% CI 26.89-42.50) HU and 31.35±6.76 (95% CI 14.57-48.14) HU, respectively (p=0.565). At the second stage (HUAC 2), mean values were 34.61±7.61 (95% CI 27.57-41.65) HU and 22.04±3.32 (95% CI 13.79-30.30) HU, respectively (p=0.028). Significant differences could indicate important changes in physiological state. At the third stage (HUAC 3), mean values were 37.14±7.21 (95% CI 30.47-43.80) HU and 19.44±3.51 (95% CI 10.71-28.16) HU, respectively (p=0.004).

Conclusion: Despite the obvious importance of traditional methods for diagnosing nutritional deficiency, it is necessary to expand the list of perspective and more sensitive methods for prevention of nutritional disorders in patients with external duodenal fistulas. The proposed method for assessing the density of lumbar muscles has an important prognostic value and allows assessing the severity of catabolism upon admission and in follow-up period.