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Computed Tomography-Measured Psoas Muscle Density as a Predictive Factor for Hypophosphatemia Associated With
Megan Ireland1, Wilson Lo1, Michael Villarreal1
1Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University, Columbus, Ohio, USA.
JPEN. Journal of Parenteral and Enteral Nutrition
|June 23, 2020
Summary
Low psoas muscle density on CT scans can predict hypophosphatemia in patients starting parenteral nutrition (PN), indicating a risk for refeeding syndrome (RFS). This finding helps identify high-risk individuals needing closer monitoring and adjusted PN initiation.
Area of Science:
- Medical Imaging
- Clinical Nutrition
- Critical Care Medicine
Background:
- Refeeding syndrome (RFS) can complicate parenteral nutrition (PN) initiation after starvation, causing electrolyte imbalances like hypophosphatemia.
- Traditional RFS risk factors (weight loss, low BMI) have weak predictive power.
- Psoas muscle density, measured by CT, is explored as a novel predictor of RFS-related hypophosphatemia.
Purpose of the Study:
- To investigate the utility of CT-measured psoas muscle density in predicting hypophosphatemia in patients receiving PN.
- To identify a quantifiable measure for assessing nutrition risk and RFS development.
Main Methods:
- Retrospective analysis of 109 surgical patients who received PN and had a recent abdominal CT scan.
- Assessment of psoas muscle density using Hounsfield unit average calculation (HUAC).
- Correlation of low HUAC (<25) with changes in serum phosphate levels and clinical outcomes (e.g., mechanical ventilation days).
Main Results:
- Patients in the lowest quartile of psoas muscle density (HUAC <25) showed a significant decrease in phosphate levels post-PN initiation.
- A significant difference in serum phosphate values on PN day 3 was observed in patients with low muscle density.
- Lower psoas muscle density was associated with longer durations of mechanical ventilation.
Conclusions:
- CT-measured psoas muscle density effectively predicts the development of hypophosphatemia in patients starting PN.
- A mean psoas HUAC <25 serves as an indicator for increased RFS risk.
- Identifying high-risk patients allows for proactive measures, such as increased phosphate supplementation and slower PN titration.
