Association of Thoracic Computed Tomographic Measurements and Outcomes in Patients with Hematologic Malignancies Requiring Mechanical Ventilation
Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes.Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation.Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. We included patients with thoracic CT imaging completed between 1 month before and 48 hours after intensive care unit (ICU) admission. We assessed the association of carinal skeletal muscle cross-sectional area (CSA), subcutaneous fat CSA, and fat index (fat/skeletal muscle ratio) with time to liberation from mechanical ventilation within 28 days. We accounted for the competing event of death within 28 days of mechanical ventilation.Results: One hundred fifty-six patients were included; the mean age was 57 years (standard deviation 14) and 39% were female. Thirty-seven percent had received a hematopoietic stem cell transplant, and the median ratio of arterial oxygen tension/pressure to fraction of inspired oxygen was 134 mm Hg (interquartile range [IQR], 92-205). Median skeletal muscle CSA was 68 cm2 (IQR, 54-88) and subcutaneous fat CSA was 38 cm2 (IQR, 27-52). Forty-two percent of patients were liberated from mechanical ventilation within 28 days and 56% died in the ICU. Subcutaneous fat CSA (subdistribution hazard ratio [sHR], 0.81; 95% confidence interval [95% CI], -0.68 to 0.97) and fat index (sHR, 0.81; 95% CI, -0.68 to 0.97) were significantly associated with longer time to liberation from mechanical ventilation. Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23).Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation.
| Errataetall: |
CommentIn: Ann Am Thorac Soc. 2021 Aug;18(8):1431-1432. - PMID 33625953 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
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| Enthalten in: |
Annals of the American Thoracic Society - 18(2021), 7 vom: 12. Juli, Seite 1219-1226 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Elfassy, Michael D [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory failure |
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| Anmerkungen: |
Date Completed 06.09.2021 Date Revised 22.10.2021 published: Print CommentIn: Ann Am Thorac Soc. 2021 Aug;18(8):1431-1432. - PMID 33625953 Citation Status MEDLINE |
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| doi: |
10.1513/AnnalsATS.202008-914OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM319966755 |
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| 100 | 1 | |a Elfassy, Michael D |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Association of Thoracic Computed Tomographic Measurements and Outcomes in Patients with Hematologic Malignancies Requiring Mechanical Ventilation |
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| 500 | |a CommentIn: Ann Am Thorac Soc. 2021 Aug;18(8):1431-1432. - PMID 33625953 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes.Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation.Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. We included patients with thoracic CT imaging completed between 1 month before and 48 hours after intensive care unit (ICU) admission. We assessed the association of carinal skeletal muscle cross-sectional area (CSA), subcutaneous fat CSA, and fat index (fat/skeletal muscle ratio) with time to liberation from mechanical ventilation within 28 days. We accounted for the competing event of death within 28 days of mechanical ventilation.Results: One hundred fifty-six patients were included; the mean age was 57 years (standard deviation 14) and 39% were female. Thirty-seven percent had received a hematopoietic stem cell transplant, and the median ratio of arterial oxygen tension/pressure to fraction of inspired oxygen was 134 mm Hg (interquartile range [IQR], 92-205). Median skeletal muscle CSA was 68 cm2 (IQR, 54-88) and subcutaneous fat CSA was 38 cm2 (IQR, 27-52). Forty-two percent of patients were liberated from mechanical ventilation within 28 days and 56% died in the ICU. Subcutaneous fat CSA (subdistribution hazard ratio [sHR], 0.81; 95% confidence interval [95% CI], -0.68 to 0.97) and fat index (sHR, 0.81; 95% CI, -0.68 to 0.97) were significantly associated with longer time to liberation from mechanical ventilation. Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23).Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a acute respiratory failure | |
| 650 | 4 | |a computed tomography | |
| 650 | 4 | |a hematologic malignancy | |
| 650 | 4 | |a sarcopenia | |
| 650 | 4 | |a subcutaneous fat | |
| 700 | 1 | |a Ferreyro, Bruno L |e verfasserin |4 aut | |
| 700 | 1 | |a Rozenberg, Dmitry |e verfasserin |4 aut | |
| 700 | 1 | |a Sklar, Michael C |e verfasserin |4 aut | |
| 700 | 1 | |a Mathur, Sunita |e verfasserin |4 aut | |
| 700 | 1 | |a Detsky, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a Goligher, Ewan C |e verfasserin |4 aut | |
| 700 | 1 | |a Mehta, Sangeeta |e verfasserin |4 aut | |
| 700 | 1 | |a Prica, Anca |e verfasserin |4 aut | |
| 700 | 1 | |a Thyagu, Santhosh |e verfasserin |4 aut | |
| 700 | 1 | |a Kerzner, Sophia |e verfasserin |4 aut | |
| 700 | 1 | |a Hanneman, Kate |e verfasserin |4 aut | |
| 700 | 1 | |a Munshi, Laveena |e verfasserin |4 aut | |
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