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Resident PGY 1
Henry Ford Hospital
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a serious complication of acute pancreatitis. However, limited literature exists pertaining to patient characteristics that can help predict the development of ARDS among patients with acute pancreatitis. Sarcopenia, based on psoas muscle area on imaging, has been predictive of outcomes after surgery. We hypothesized that sarcopenia would correlate with development of ARDS in patients admitted for acute pancreatitis. Methods: We performed a retrospective study of patients that were admitted to the ICU for acute pancreatitis at our institution. Patients that did not have a CT of their abdomen were excluded from the study. Patient characteristics including demographics, medical history, BMI, labs at admission, and functional status were collected. An average psoas muscle area for each patient was calculated at the level of L3 and standardized to their height. Sarcopenia was determined by gender-based cutoffs of the psoas areas. We then performed both univariate and multivariate analysis to determine significant covariates in the development of ARDS. Results: We included 218 patients in the study. Of these patients, 32 (14.7%) developed ARDS. In univariate analysis, there was no significant difference in the proportion of patients with ARDS that were sarcopenic (50.0% vs 35.7%, p = 0.12). The mean age was significantly higher in those that developed ARDS (58.0 vs 47.3, p<0.01). There was no difference in gender (59.4% male vs 55.9%, p = 0.72), mean BMI (30.1 vs 29.1, p = 0.52), mean albumin (2.71 vs 2.85, p = 0.48), and mean serum creatinine (2.01 vs 1.52, p = 0.14). Patients with ARDS had a higher proportion of biliary etiology (38.7% vs 14.9%, p < 0.01), history of coronary artery disease (21.9% vs 11.4%, p = 0.01) and COPD (25.0% vs 10.3%, p = 0.02). Patients that developed ARDS also had a lower proportion of independent patients (54.2% vs 80.9%, p<0.01). In multivariate analysis, the only significant predictors for ARDS were the presence of sarcopenia (OR = 5.15, 95% CI: 1.23-21.49) and a history of COPD (OR = 6.60, 95% CI: 1.46-29.96). Conclusion: In our single institute retrospective study, we have found a significant relationship between the presence of sarcopenia based on psoas muscle area and the development of ARDS. Further research on utilizing this simple measurement to risk-stratify patients with acute pancreatitis is warranted.
Fisher, Charles; Kandagatla, Pridvi; Gupta, Arielle H; Abbas, Daniyal; Knisely, Beatrice; Cho, Rachel; Schmoekel, Nathan; and Stassinopoulos, Jerry, "Psoas Muscle Area Predicts Acute Respiratory Distress Syndrome in Acute Pancreatitis" (2019). Clinical Research. 24.