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Validation by CT scan of quadriceps muscle thickness measurement by ultrasound in acute kidney injury

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Abstract

Background

Accelerated muscle wasting still represents a major issue in critically ill patients. However, a key problem in the intensive care unit is the lack of adequate tools for bedside evaluation of muscle mass. Moreover, when acute kidney injury (AKI) coexists, fluid overload and/or rapid fluid shifts due to renal replacement therapies that frequently occur and may interfere with muscle mass assessment. The purpose of this study is to validate muscle ultrasound (US) by a gold standard (muscle CT scan) for the assessment of quadriceps muscle thickness in critically ill patients with AKI.

Methods

Quadriceps rectus femoris thickness and quadriceps vastus intermedius thickness of critically ill patients with AKI were blindly assessed at the same leg sites by both US and computed tomography (CT) scan. Using bivariate mixed-model linear regression analysis, we estimated, average difference in thickness between measurement sites, agreement (differential and proportional bias) of US compared to CT, and precision of the two methods, and eventually performed Bland–Altman analysis for repeated measurements on pooled results.

Results

We analyzed 233 couples of measurements (30 patients). Average muscle thickness ranged between 1.0 and 1.6, depending on the measurement site. When comparing US to CT, both the observed differential bias (between + 0.04 and + 0.26 cm depending on the muscle site) and the proportional bias (between 82 and 98% of the reference values, depending on the muscle site) were not statistically significant. However, precision analysis showed that US scan tended to be slightly less precise in comparison to CT. Bland–Altman analysis on pooled results showed that the 95% limits of agreement between the US and CT were narrow, ranging from − 0.34 to + 0.36 cm.

Conclusion

In critically ill patients with AKI, quadriceps muscle thickness assessment based on US is unbiased, although it occurs with a minor loss of precision compared to CT.

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Acknowledgements

AS is the recipient of a young investigator research grant by the Italian Society of Artificial Nutrition and Metabolism (Società Italiana di Nutrizione Artificiale e Metabolismo, SINPE) for the project: “Valutazione dello stato nutrizionale nell’insufficienza renale mediante ecografia del muscolo quadricipite femorale” (“Nutritional assessment of patients with chronic kidney disease and acute kidney injury by ultrasound of the quadriceps femoris muscle”).

Funding

This work was supported in part by the Italian Society of Artificial Nutrition and Metabolism (Società Italiana di Nutrizione Artificiale e Metabolismo, SINPE).

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Authors and Affiliations

  1. UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy

    Alice Sabatino, Giuseppe Regolisti, Francesca di Mario, Francesco Peyronel, Umberto Maggiore & Enrico Fiaccadori

  2. Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy

    Giuseppe Regolisti, Francesca di Mario, Francesco Peyronel, Umberto Maggiore & Enrico Fiaccadori

  3. Radiologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy

    Andrea Ciuni & Anselmo Palumbo

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  1. Alice Sabatino
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Correspondence to Enrico Fiaccadori.

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40620_2019_659_MOESM1_ESM.tif

Online resource 1. Muscle thickness measured by ultrasound (in cm). QRFT, Quadriceps rectus femoris thickness; QVIT, Quadriceps vastus intermedius thickness. (TIFF 974 kb)

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Sabatino, A., Regolisti, G., di Mario, F. et al. Validation by CT scan of quadriceps muscle thickness measurement by ultrasound in acute kidney injury. J Nephrol 33, 109–117 (2020). https://doi.org/10.1007/s40620-019-00659-2

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