Bedside assessment of quadriceps muscle by ultrasound after admission for acute exacerbations of chronic respiratory disease

Greening, Neil J.; Harvey-Dunstan, Theresa C.; Chaplin, Emma J.; Vincent, Emma E.; Morgan, Mike D.; Singh, Sally J.; Steiner, Michael C.

Abstract

RATIONALE: Hospitalization represents a major event for the patient with chronic respiratory disease. There is a 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 1 year, including measures of lower limb muscle as part of a larger clinical trial.
METHODS: Patients hospitalized 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.
MEASUREMENTS AND MAIN RESULTS: One hundred and ninety-one patients (mean age, 71.6 [SD, 9.1] yr) were recruited. One hundred and thirty (68%) were either readmitted or died. Factors associated with readmission or death were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08; P = 0.015), Medical Research Council (MRC) dyspnea grade (OR, 4.57; 95% CI, 2.62-7.95; P  P less than 0.001), home oxygen use (OR, 12.4; 95% CI, 4.53–33.77; P less than 0.001), quadriceps (rectus femoris) cross-sectional area (Qcsa) (OR, 0.34; 95% CI, 0.17–0.65; P = 0.001), and hospitalization in the previous year (OR, 4.82; 95% CI, 2.42–9.58; P less than 0.001). In the multivariate analyses, home oxygen use (OR, 4.80; 95% CI, 1.68–13.69; P = 0.003), MRC dyspnea grade (OR, 2.57; 95% CI, 1.44–4.59; P = 0.001), Qcsa (OR, 0.46; 95% CI, 0.22–0.95; P = 0.035), and previoushospitalization (OR, 3.04; 95% CI, 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] vs. 12.2 [SD, 23.5] d; P = 0.007).
Conclusions: Smaller quadriceps muscle size, as measured by 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.

Citation

Greening, N. J., Harvey-Dunstan, T. C., Chaplin, E. J., Vincent, E. E., Morgan, M. D., Singh, S. J., & Steiner, M. C. (2015). Bedside assessment of quadriceps muscle by ultrasound after admission for acute exacerbations of chronic respiratory disease. American Journal of Respiratory and Critical Care Medicine, 192(7), 810-816. doi:10.1164/rccm.201503-0535oc

• Journal Article Type: Article
• Acceptance Date: Jun 10, 2015
• Online Publication Date: Jun 11, 2015
• Publication Date: Oct 1, 2015
• Deposit Date: Feb 21, 2019
• Journal: American Journal of Respiratory and Critical Care Medicine
• Print ISSN: 1073-449X
• Electronic ISSN: 1535-4970
• Publisher: American Thoracic Society
• Peer Reviewed: Peer Reviewed
• Volume: 192
• Issue: 7
• Pages: 810-816
• DOI: https://doi.org/10.1164/rccm.201503-0535oc
• Public URL: https://nottingham-repository.worktribe.com/output/1575495
• Publisher URL: https://www.atsjournals.org/doi/10.1164/rccm.201503-0535OC