A pilot study of change in fracture risk in patients with acute respiratory distress syndrome.
Author(s)
Type
Journal Article
Abstract
INTRODUCTION: Acute skeletal muscle wasting is a major contributor to post critical illness physical impairment. However, the bone response remains uncharacterized. We prospectively investigated the early changes in bone mineral density (BMD) and fracture risk in critical illness. METHODS: Patients were prospectively recruited ≤ 24 hours following intensive care unit (ICU) admission to a University Teaching and a Community Hospital (August 2009 to April 2011).All were aged >18 years and expected to be intubated for >48 hours, spend >7 days in critical care and survive ICU admission. Forty-six patients were studied (55.3% male) with an age of 54.4 years (95% Confidence Interval (CI) 49.1-59.6)years and APACHE II score 23.9 (95%CI 22.4-25.5).Calcaneal Dual X-ray Absorptiometry (DXA) assessment of BMD was performed on day 1 and 10. Increase in fracture risk was calculated from the change in T-score. RESULTS: BMD did not change between day 1 and 10 in the cohort overall (0.434 (95%CI 0.405-0.463) vs. 0.425 g/cm(2) (95%CI 0.399-0.450), p = 0.58).Multivariable logistical regression revealed admission corrected calcium (OR 1.980 (95%CI 1.089-3.609), p = 0.026) and admission PaO2 to FiO2 ratio (OR 0.916 (95%CI 0.833-0.998), p = 0.044)to be associated with >2% loss of BMD. Patients with Acute Respiratory Distress Syndrome had a greater loss in BMD than those without (-2.81 (95%CI -5.73-0.118)%, n = 34 vs. 2.40 (95%CI 0.204-4.586)%,n = 12, p = 0.029). In the 34 patients with Acute Respiratory Distress Syndrome, fracture risk increased by 19.4% (95%CI 13.9-25.0%). CONCLUSIONS: Patients with acute respiratory distress syndrome demonstrated early and rapid bone demineralisation with associated increase in fracture risk.
Date Issued
2015-04-14
Date Acceptance
2015-03-20
Citation
Critical Care, 2015, 19
ISSN
1364-8535
Publisher
BioMed Central
Journal / Book Title
Critical Care
Volume
19
Copyright Statement
© 2015 Rawal et al.; licensee BioMed Central.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
License URL
Publication Status
Published
Article Number
165