Nguyen Thi Huyen Trang, Le Thi Viet Hoa, Pham Dang Hai
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引用次数: 0
Abstract
Background: Bedside ultrasound is increasingly utilized to assess muscle mass in critically ill patients, providing a noninvasive and real-time tool for early risk stratification. Muscle wasting is known to be associated with adverse outcomes in septic shock, but its prognostic value using ultrasound in this population remains underexplored. This study aimed to investigate the association between changes in rectus femoris cross-sectional area (CSA), assessed by bedside ultrasound, and 28-day mortality in patients with septic shock.
Methods: This prospective observational study enrolled adult patients (≥18 years) with septic shock admitted to the intensive care unit (ICU), diagnosed according to Sepsis-3 criteria. Ultrasound assessments of rectus femoris CSA were performed at baseline (day 0), day 4, and day 7 using a linear transducer. The primary outcome was 28-day mortality. Percentage change in CSA was calculated, and its association with mortality was evaluated using multivariable logistic regression and receiver operating characteristic (ROC) analysis.
Results: A total of 116 patients were included. The 28-day mortality rate was 20.7%. Rectus femoris CSA decreased significantly over time, with a median reduction of -0.35 cm² (IQR: -0.62 to -0.21) by day 7. The percentage decrease in CSA was significantly greater in non-survivors at both day 4 (-10.0% vs -8.5%, P = .041) and day 7 (-15.4% vs -13.5%, P = .044). In multivariable analysis, percentage CSA loss at day 7 was independently associated with 28-day mortality (OR 0.94, 95% CI 0.88-0.99, P = .036). ROC analysis yielded an area under the curve (AUC) of 0.65 (95% CI 0.52-0.78) for %CSA reduction at day 7, with a -15.28% cut-off showing 66.7% sensitivity and 61.9% specificity.
Conclusions: Serial ultrasound assessment of rectus femoris CSA is a feasible and reproducible method for monitoring muscle wasting in septic shock. While the predictive performance was modest, serial ultrasound measurements may serve as a valuable adjunct in early mortality risk stratification in critically ill patients.
背景:床边超声越来越多地用于评估危重患者的肌肉质量,为早期风险分层提供了一种无创和实时的工具。众所周知,肌肉萎缩与感染性休克的不良后果有关,但在这一人群中使用超声诊断其预后价值仍未得到充分探讨。本研究旨在探讨床边超声评估的股直肌横断面积(CSA)变化与感染性休克患者28天死亡率之间的关系。方法:本前瞻性观察性研究纳入重症监护病房(ICU)诊断为脓毒症-3标准的脓毒症休克成年患者(≥18岁)。在基线(第0天)、第4天和第7天使用线性换能器对股直肌CSA进行超声评估。主要终点为28天死亡率。计算CSA的百分比变化,并使用多变量logistic回归和受试者工作特征(ROC)分析评估其与死亡率的关系。结果:共纳入116例患者。28天死亡率为20.7%。随着时间的推移,股直肌CSA显著下降,到第7天,中位减少-0.35 cm²(IQR: -0.62至-0.21)。在第4天,非幸存者的CSA下降百分比明显更大(-10.0% vs -8.5%, P =。041)和第7天(-15.4% vs -13.5%, P = 0.044)。在多变量分析中,第7天CSA损失百分比与28天死亡率独立相关(OR 0.94, 95% CI 0.88-0.99, P = 0.036)。ROC分析显示,第7天CSA %减少的曲线下面积(AUC)为0.65 (95% CI 0.52-0.78),截止值为-15.28%,敏感性为66.7%,特异性为61.9%。结论:连续超声评价股直肌CSA是监测感染性休克患者肌肉萎缩的一种可行且可重复的方法。虽然预测性能不高,但连续超声测量可以作为危重患者早期死亡风险分层的有价值的辅助手段。
期刊介绍:
Journal of Intensive Care Medicine (JIC) is a peer-reviewed bi-monthly journal offering medical and surgical clinicians in adult and pediatric intensive care state-of-the-art, broad-based analytic reviews and updates, original articles, reports of large clinical series, techniques and procedures, topic-specific electronic resources, book reviews, and editorials on all aspects of intensive/critical/coronary care.