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Bedside Assessment of Quadriceps Muscle Using Ultrasound Following Admission for Acute Exacerbations of Chronic Respiratory Disease.
Am J Respir Crit Care Med. 2015 Jun 11;
Authors: Greening NJ, Harvey-Dunstan TC, Chaplin EJ, Vincent EE, Morgan MD, Singh SJ, Steiner MC
Abstract
RATIONALE: Hospitalisation represents a major event in patients with chronic respiratory disease with high risk of readmission, which over the longer term may be related more closely to the underlying condition of the patient, such as skeletal muscle dysfunction.
OBJECTIVES: We assessed the risk of hospital readmission at one year, including measures of lower limb muscle as part of a larger clinical trial.
METHODS: Patients hospitalised with an exacerbation of chronic respiratory disease underwent measures of muscle function including quadriceps ultrasound. Independent factors influencing time to hospital readmission or death were identified. Patients were classified into four quartiles based on quadriceps size and compared.
RESULTS: 191 patients (mean age 71.6 [SD 9.1] years) were recruited. 130 (68%) were either readmitted or died. Factors associated with readmission or death were age (odds ratio 1.05, 95% CI 1.01-1.08; p=0.015), MRC dyspnoea grade (4.57, 2.62-7.95; p<0.001), home oxygen use (12.4 4.53-33.77; p<0.001), quadriceps cross sectional area (Qcsa) (0.34, 0.17-0.65, p=0.001) and hospitalisation in the previous year (4.82, 2.42-9.58; p<0.001). In the multivariate analyses, home oxygen use (4.80, 1.68-13.69; p=0.003), MRC dyspnoea grade (2.57, 1.44-4.59, p=0.001), Qcsa (0.46, 0.22-0.95; p=0.035) and previous hospitalisation (3.04, 1.47-6.29; p=0.003) were independently associated with readmission or death. Patients with the smallest muscle spent more days in hospital than those with largest muscle (28.1 (SD 33.9) days versus 12.2 (SD 23.5) days; p=0.007).
CONCLUSIONS: Quadriceps muscle measured using ultrasound in the acute care setting is an independent risk factor for unscheduled readmission or death, which may have value both in clinical practice and for risk stratification.
PMID: 26068143 [PubMed - as supplied by publisher]