Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia

Ga Ram Lee; Seok Hoon Ko; Hang Sung Choi; Hoon Pyo Hong; Jong Seok Lee; Ki Young Jeong

doi:10.15441/ceem.23.142

Clin Exp Emerg Med > Accepted Articles

Original Article

doi: https://doi.org/10.15441/ceem.23.142 [Accepted]

Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia

Ga Ram Lee

, Seok Hoon Ko

, Hang Sung Choi

, Hoon Pyo Hong, Jong Seok Lee

, Ki Young Jeong

Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea

Correspondence Seok Hoon Ko Tel: + 82-2-958-8281, Fax: +82-2-958-9689, Email: bpm480@khu.ac.kr

Received: October 8, 2023. Revised: November 1, 2023. Accepted: November 1, 2023. Published online: January 29, 2024.

ABSTRACT

Objective
This study investigated the associations among paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP).
Methods
This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power.
Results
Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with a low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992–0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality.
Conclusion
A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.

Keywords: Pneumonia; Prognosis; Paraspinal muscle index; Emergency departments