CT-derived psoas muscle area and density are associated with length of stay and discharge disposition after liver transplantation

Jessica Thul; Timothy L Pruett; Levi M Teigen

doi:10.1016/j.clnesp.2023.04.028

CT-derived psoas muscle area and density are associated with length of stay and discharge disposition after liver transplantation

Clin Nutr ESPEN. 2023 Jun:55:434-439. doi: 10.1016/j.clnesp.2023.04.028. Epub 2023 Apr 29.

Authors

Jessica Thul¹, Timothy L Pruett², Levi M Teigen³

Affiliations

¹ MHealth Fairview, University of Minnesota Medical Center, Minneapolis, MN, 55455, USA. Electronic address: jessica.thul@fairview.org.
² Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA. Electronic address: tlpruett@umn.edu.
³ Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55108, USA. Electronic address: teige027@umn.edu.

PMID: 37202080
DOI: 10.1016/j.clnesp.2023.04.028

Abstract

Background & aims: Prolonged length of stay (LOS) and discharge disposition following liver transplantation are associated with postoperative complications and increased healthcare utilization. This study evaluated the relationship between CT-derived psoas muscle measurements and hospital LOS, intensive care unit (ICU) LOS, and discharge disposition after liver transplant. The psoas muscle was chosen given its ease of measurement with any radiological software. A secondary analysis assessed the relationship between the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics (ASPEN/AND) malnutrition diagnosis criteria and CT-derived psoas muscle measures.

Methods: CT-derived measures of psoas muscle density (mHU) and cross-sectional area at the level of the third lumbar vertebrae were obtained from preoperative CT scans of liver transplant recipients. Cross-sectional area measures were corrected for body size to generate a psoas area index variable (cm²/m²; PAI).

Results: Each 1-unit increase in PAI was associated with a reduced hospital LOS of 4 days (R² = 0.07). Each 5-unit increase in mean Hounsfield units (mHU) was associated with a reduced hospital and ICU LOS of 5 and 1.6 days, respectively (R² = 0.22 and 0.14, respectively). Mean PAI and mHU were higher in patients who discharged to home. PAI was reasonably identified through ASPEN/AND malnutrition criteria, but there was no difference in mHU between those with and without malnutrition.

Conclusion: Measures of psoas density were associated with both hospital and ICU LOS and discharge disposition. PAI was associated with hospital LOS and discharge disposition. CT-derived measures of psoas density may be a valuable complement to preoperative liver transplant nutrition assessment using traditional ASPEN/AND malnutrition criteria.

Keywords: CT; Length of stay; Liver transplant; Malnutrition; Sarcopenia.

MeSH terms

Humans
Length of Stay
Liver Transplantation*
Malnutrition*
Patient Discharge
Psoas Muscles / diagnostic imaging
Tomography, X-Ray Computed
United States