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Total Psoas Area and Psoas Density Assessment in COVID-19 Patients Using CT Imaging – Could Muscle Mass Alteration During Intensive Care Hospitalization be Determined?

Oana Elena Branea

Oana Elena Branea

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Branea, Oana Elena
, 
Anca Gabriela Vlad

Anca Gabriela Vlad

Targu Mures County Emergency Clinical HospitalRomania
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Vlad, Anca Gabriela
, 
Mihai Pui

Mihai Pui

Targu Mures County Emergency Clinical HospitalRomania
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Pui, Mihai
, 
Diana Andreea Becica

Diana Andreea Becica

Targu Mures County Emergency Clinical HospitalRomania
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Becica, Diana Andreea
, 
Mihai Emanuel Becica

Mihai Emanuel Becica

Targu Mures County Emergency Clinical HospitalRomania
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Becica, Mihai Emanuel
, 
AnaMaria Romina Budeanu

AnaMaria Romina Budeanu

Targu Mures County Emergency Clinical HospitalRomania
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Budeanu, AnaMaria Romina
, 
Razvan Gabriel Budeanu

Razvan Gabriel Budeanu

Targu Mures County Emergency Clinical HospitalRomania
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Budeanu, Razvan Gabriel
, 
Florin Stoica

Florin Stoica

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Stoica, Florin
 oraz 
Alexandra Elena Lazar

Alexandra Elena Lazar

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu MuresRomania
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Lazar, Alexandra Elena
  
14 lis 2023
Total Psoas Area and Psoas Density Assessment in COVID-19 Patients Using CT Imaging – Could Muscle Mass Alteration During Intensive Care Hospitalization be Determined?'s Cover Image
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Kategoria artykułu: Research Article
Data publikacji: 14 lis 2023
Zakres stron: 218 - 229
Otrzymano: 19 cze 2023
Przyjęty: 19 wrz 2023
DOI: https://doi.org/10.2478/jccm-2023-0026
Słowa kluczowe
© 2023 Oana Elena Branea et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig.1.

Flow chart
Flow chart

Fig. 2.

CT psoas muscle evaluation at the third lumbar vertebrae. A. Cross-sectional area evaluation showing muscle area. B. Evaluation of muscle density in Hounsfiled unit.
CT psoas muscle evaluation at the third lumbar vertebrae. A. Cross-sectional area evaluation showing muscle area. B. Evaluation of muscle density in Hounsfiled unit.

Fig. 3.

Box-plot comparing right and left changes in psoas muscle area (A) and psoas muscle HU (B).
Box-plot comparing right and left changes in psoas muscle area (A) and psoas muscle HU (B).

Fig. 4.

AUC-ROC for psoas area and IMV. A. IMV <24 hours. B. IMV 24-96 hours. C. IMC >96 hours.
AUC-ROC for psoas area and IMV. A. IMV <24 hours. B. IMV 24-96 hours. C. IMC >96 hours.

Fig. 5.

AUC-ROC for psoas HU and IMV. A. IMV <24 hours. B. IMV 24-96 hours. C. IMC >96 hours.
AUC-ROC for psoas HU and IMV. A. IMV <24 hours. B. IMV 24-96 hours. C. IMC >96 hours.

Fig. 6.

Right and left psoas analysis (area - A and HU - B) linked to the patients outcome
Right and left psoas analysis (area - A and HU - B) linked to the patients outcome

AUC-ROC for psoas HU and IMV duration

IMV duration (hours) Psoas (HU) Criterion AUC-ROC 95% CI P Sn 95% CI Sp 95% CI
<24 Right >−0.01 0.850 0.640–0.963 0.0001 100.00 29.2–100.0 75.00 50.9–91.3
Left >−7.515 0.683 0.458–0.859 0.29 100.00 29.2–100.0 40.00 19.1–63.9
24–96 Right ≤−2.675 0.595 0.373–0.792 0.53 100.00 15.8–100.0 47.62 25.7–70.2
Left >−5.505 0.548 0.329–0.754 0.70 100.00 15.8–100.0 47.62 25.7–70.2
>96 Right ≤−4.12 0.715 0.491–0.882 0.049 69.23 38.6–90.9 70.00 34.8–93.3
Left ≤−4.27 0.623 0.399–0.814 0.31 69.23 38.6–90.9 60.00 26.2–87.8

Dynamic changes in total psoas area and psoas HU in two CT scan evaluations

CT scan parameter CT1 (A+B) Mean±SD CT2 (A+B) Mean±SD Difference Mean p difference 1st and 2nd
Right TPA(cm2) 7.82±2.76 7.70±2.90 −0.12 0.88
Left TPA(cm2) 8.52±3.56 7.92±3.20 −0.59 0.56
Right psoas HU 37.4±10.21 33.16±10.31 −4.24 0.17
Left psoas HU 39.9±10.06 35.93±9.33 −3.99 0.17

AUC-ROC for the Psoas area and IMV duration

IMV duration (hours) Psoas area (cm2) Criterion AUC-ROC 95% CI p Sn 95% CI Sp 95% CI
<24 Right >−0.654 0.583 0.362–0.783 0.53 100.00 29.2–100.0 40.00 19.1–63.9
Left ≤−1.205 0.667 0.442–0.847 0.39 66.67 9.4–99.2 80.00 56.3–94.3
24–96 Right >0.275 0.929 0.741–0.994 0.0001 100.00 15.8–100.0 85.71 63.7–97.0
Left >0.307 0.833 0.621–0.954 0.0001 100.00 15.8–100.0 80.95 58.1–94.6
>96 Right ≤−0.654 0.600 0.377–0.796 0.43 53.85 25.1–80.8 90.00 55.5–99.7
Left >0.599 0.508 0.294–0.720 0.951 23.08 5.0–53.8 100.00 69.2–100.0

AUC-ROC for the negative outcome (deceased patients)

CT scan parameter Criterion AUC-ROC 95% CI P Sn 95% CI Sp 95% CI
Right psoas area >−0.45 0.571 0.351–0.773 0.610 56.2 29.9–80.2 71.4 29.0–96.3
Right psoas HU >−12.59 0.571 0.350–0.773 0.633 81.2 54.4–96.0 42.9 9.9–81.6
Left psoas area >−0.319 0.509 0.295–0.721 0.944 43.7 19.8–70.1 85.7 42.1–99.6
Left psoas HU >−10.35 0.643 0.418–0.829 0.362 93.7 69.8–99.8 57.1 18.4–90.1

Patients’ characteristics

Demographics All patients (n=22)
Male sex (n, %) 8 (36.4%)
Age (years, mean±SD) 71.09±10.57
ICU admission diagnostics
ARF (n, %) 11 (50%)
Other (n, %) 11 (50%)
Severity scores
qCSI (mean±SD) 8.73±2.27
CHOSEN score (median (min-max)) 13 (1–44)
modified CHOSEN score (mean±SD) 19.33±9.81
Hospital stay characteristics
LOS in Hospital (days) (median (min-max)) 18 (10–91)
LOS in ICU (days) (median (min-max)) 11 (2–91)
Time period between CTpsoas1 and CT psos2 (days) (medain (min-max)) 10 (3–19)
ICU admission oxygenation
Facial mask (n, %) 9 (40.9%)
NIV-CPAP (n, %) 2 (9.1%)
IMV (n, %) 11 (50%)
ICU stay oxygenation
Need for NIV-CPAP (n, %) 5 (22.7%)
Need for IMV (n, %) 18 (81.8%)
IMV <24 hours 3 (13.6%)
IMV 24–96 hours 2 (9.1%)
IMV >96 hours 13 (59.1%)
Admission laboratory report
WBC (mean±SD) 12.307±8.421
Neutrophils (mean±SD) 10.381±7.924
Lymphocytes (mean±SD) 0.958±0.783
Platelets (median (min-max)) 262.500 (90.000–1081.000)
NLR (median (min-max)) 10.537 (3.758–66.631)
PLR (median (min-max)) 382.907 (59.644–1184.2100)
SII (median (min-max)) 2361.589 (474.000–42981.947)
CRP (median (min-max)) 106.810 (5.660–353.300)
Creatinine (median (min-max)) 1.025 (0.140–8.160)
Glucose (mean±SD) 149.136±73.879

Assessment of total psoas area and psoas HU in the first and second CT scan

CT scan parameter Investigator A Mean±SD Investigator B Mean±SD Mean Difference p difference A and B
Right TPA1(cm2) 8.01±2.70 7.72±2.97 −0.29 0.73
Right TPA2(cm2) 8.39±3.19 7.08±2.92 −1.31 0.15
Left TPA1(cm2) 8.71±3.80 8.41±3.42 −0.29 0.78
Left TPA2(cm2) 8.19±3.20 7.70±3.27 −0.48 0.61
Right psoasHU1 35.95±10.86 39.34±10.27 3.38 0.28
Right psoasHU2 30.55±13.00 36.40±10.65 5.83 0.10
Left psoasHU1 38.49±10.35 41.86±10.99 3.37 0.29
Left poasHU2 34.68±11.99 37.86±9.69 3.18 0.33

STROBE checklist for the study’s methods

Study design Cohort, observational, retrospective and monocentric
Setting

Anaesthesia and Intensive Care Unit, Târgu Mureș Emergency County Clinical Hospital, Romania

Period of recruitment: August 2020 – December 2022

Exposure: COVID-19

Follow-up: two psoas CT scans

Data collection: electronic medical and imagistic records
Participants Eligibility criteria: ≥ 18 years of age admitted in the ICU for at least 24 hours, positively tested for SARS-COV2 by real-time polymerase chain reaction (RT-PCR), and who had two eligible CT scans for psoas analysis
Variables

Main outcomes: analysis of the changes in psoas area and psoas HU in critically ill

Predictors: length of stay in hospital, length of stay in ICU, mechanical ventilation

Diagnostic criteria: psoas analysis by CT scan
Data sources/measurement

Data sources: Picture Archiving and Communicating System and RadiAnt DICOM Viewer

Measurement: Psoas muscle area and density (HU) were measured at the level of the third lumbar vertebrae
Study size Inclusion of critically ill patients who were hospitalized in the ICU for more than 24h, adults, that had two eligible CT scans for psoas assessment
Statistical methods

To conduct the statistical analysis, SPSS, version 27 (SPSS Inc. Chicago, IL, USA) was utilized.

Continuous data are presented as medians (minimum-maximum) or means (±standard deviation) and categorical data as proportions.

The Kolmogorov–Smirnov test was used to assess the normal distribution of continuous numerical variables. The Mann-Whitney U test was used for non-Gaussian variables, and Student’s t-test was used for the Gaussian continuous variables.

Inter-variability is performed by Bland and Altman methods.

Receiver operating characteristics curve analysis was performed.

Area under the curve values were displayed including a 95% confidence interval.

For correlations, Spearman’s coefficients were used.

A p-value of less than 0.05 was considered statistically significant.

LOS in hospital and LOS ICU correlations with psoas area and HU

CT scan (mean A+B) LOS Right psoas (cm2) Right psoas (HU) Left psoas (cm2) Left psoas (HU)
Correlation coefficient P Correlation coefficient p Correlation coefficient p Correlation coefficient p
CT scan1 Hospital 0.015 0.94 0.202 0.36 −0.054 0.810 0.362 0.09
ICU −0.349 0.11 0.417 0.02 −0.322 0.11 0.666 0.01
CT scan2 Hospital −0.087 0.70 −0.198 0.37 −0.069 0.76 −0.007 0.97
ICU −0.307 0.16 0.007 0.97 −0.263 0.23 0.250 0.26
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medycyna, Medycyna kliniczna, Medycyna wewnętrzna, Medycyna wewnętrzna, inne, Chirurgia, Chirurgia, inne, Anestezjologia, Medycyna ratunkowa i intensywna opieka medyczna
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