Utility of cross-sectional area of erector spinae muscle combined with serum GDF-15 for the diagnosis and prognosis assessment of ICU-acquired weakness in mechanically ventilated patients / 中华急诊医学杂志

ABSTRACT

Objective:To identify the clinical correlations between the cross-sectional area loss of the erector spinae muscle (ESMcsa Loss) and serum growth differentiation factor-15 (GDF-15) in mechanically ventilatied patients in ICU. In addition, to investigate their diagnostic value for ICU-acquired weakness (ICU-AW) and their predictive value for 60-day survival in mechanically ventilated patients.Methods:Ninety-two patients with acute respiratory failure, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from June 2018 to November 2019. The serum GDF-15 level was detected by ELISA, the total cross-sectional area of the right and left erector spinae muscles was calculated by CT images, and the patient's muscle strength was assessed using the British Medical Research Council (MRC) muscle strength score on day 1 and day 7. The patients were divided into the ICU-AW group and the non-ICU-AW group according to the MRC-score on the 7th day of ICU admission. The correlations between plasma GDF-15 level, ESMcsa loss, and MRC score on day 7 were investigated. The receiver operating characteristic (ROC) curve was used to calculate the predictive value of serum GDF-15, ESMcsa loss, and ESMcsa loss ratio on day 7 of mechanically ventilated patients in the diagnosis of ICU acquired muscle weakness. Moreover, the predictive value of GDF-15 and ESMcsa loss ratio on the 90-day survival status of the patients was assessed using survival curves.Results:Ninety-two patients were enrolled. According to whether the MRC-score on the 7th day was less than 48, 49 cases were included in the ICU-AW group and 43 cases in the non-ICU-AW group. The mechanical ventilation time, length of ICU stay and length of hospital stay in the ICU-AW group were higher than those in the non-ICU-AW group, and there were no significant differences in other baseline indicators. There were no significant differences in serum GDF-15, ESMcsa and MRC-score between the two groups on day 1. The GDF-15 level in the ICU-AW group was significantly higher than that in the non-ICU-AW group while ESMcsa and MRC-score were significantly lower than those in the non-ICU-AW group on day 7 [GDF-15 (pg/mL): 2529.53±625.67 vs. 1614.21±567.18; ESMcsa (cm 2): 23.76±6.85 vs. 29.15±6.5; MRC-1score: 41.10±3.35 vs. 51.23±2.84; all P <0.001]. ESMcsa loss and ESMcsa loss ratio were significantly positively correlated with serum GDF-15 levels on day 7 ( r = 0.2355 and 0.3192, respectively). ESMcsa loss and ESMcsa loss ratio were significantly negatively correlated with MRC-score ( r = -0.3072 and -0.3527, respectively). The ROC curve analysis showed that plasma GDF-15 level, ESMcsa loss, and ESMcsa loss ratio on day 7 had predictive value for ICU-AW diagnosis in mechanically ventilated patients [Areas under the ROC curve (AUC) were 0.904, 0.835, and 0.889, all P <0.001]. The 60-day survival curve demonstrated that the survival rate was 60.0% in the high GDF-15 group, while was 77.8% in the low GDF-15 group; and was 60.0% in the high ESMcsa loss ratio group, while was 80.0% in the low ESMcsa loss ratio group (all P<0.05). Conclusions:There was a significant correlation between the cross-sectional area loss of the erector spinae muscle and the increase of serum GDF-15 level after 7 days of mechanical ventilation in ICU, suggesting the acute muscle wasting and skeletal muscle hypofunction, which has certain diagnostic value for ICU-AW, and can predict the 60-day survival status of mechanically ventilated patients in ICU.