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SUN-P201: Contrast-Enhancement Influences Skeletal Muscle Density, but Not Skeletal Muscle Mass, Measurements on Computed Tomography
S128
Poster
people over 60 years old, but no formula is validated for use in African countries, including Benin. The purpose of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin. Methods: People over 60 years of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height and KH. A Bland and Altman analysis was carried out by gender and age. The percentage of predictions accurate to ± 5cm compared to the measured height was calculated. The tested formulas were Chumlea’s formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians (CC1, CC2). Results: Data from 396 subjects were analysed. The mean age was 66.6 ± 5.2 years and mean height of 165.4 ± 8.0 cm. The sex-ratio was of 4.3. The three formulas achieved 98.0% accuracy, but with 4.6% risk of error (±2 SD: −6 to +9 cm), which appeared to make them unfitted for the whole population. The predictions of the three formulas in the total population are presented in Table 1. Nevertheless, if a level of prediction ± 5 cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ.
phases for SMI and SMD were calculated using intra-class correlation coefficients (ICCs). Results: Mean SMI was 42.5 (±9.9) cm2/m2 on the unenhanced phase, compared with 42.8 (±9.9) and 43.6 (±9.9) cm2/m2 for the arterial and portal-venous phase, respectively (both p < 0.01). Mean SMD was lower for the unenhanced phase (30.9 ± 8.0 HU) compared with the arterial (38.0 ± 9.9 Hounsfield units [HU]) and portal-venous (38.7 ± 9.2 HU) phase (both p < 0.001). No significant difference was found between SMD in the portal-venous and arterial phase ( p = 0.161). The ICCs were excellent (≥0.992) for all SMIs and for SMD between the contrast-enhanced phases (0.949). The ICCs for the unenhanced phase compared with the arterial (0.676) and portal-venous (0.665) phase were considered fair to good. Conclusion: Statistically significant, but not clinically relevant differences were found in SMI between enhancement phases. Contrast-enhancement strongly influenced SMD values. Studies using this measure should therefore use the portal-venous phase of contrast-enhanced CT-examinations.
Table 1: Predictions of the three formulas studied.
J. Vieira1, G. Nunes1, C. A. Santos1 *, J. Fonseca1. 1Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
n = 396 CBP CC1 CC2
Acurate prediction (%)
Overestimation (+5 cm) (%)
Underestimation (−5 cm) (%)
83.1 80.3 78.5
12.4 15.9 18.2
4.5 3.8 3.3
Conclusion: CBP formulas seem applicable in 83% of cases (±5 cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition. Disclosure of Interest: None declared.
SUN-P201 CONTRAST-ENHANCEMENT INFLUENCES SKELETAL MUSCLE DENSITY, BUT NOT SKELETAL MUSCLE MASS, MEASUREMENTS ON COMPUTED TOMOGRAPHY J. Van Vugt1 *, R. Coebergh van den Braak1, H.-J. Schippers1, K. Veen1, S. Levolger1, R. de Bruin1, M. Koek2, W. Niessen2, J. Ijzermans1, F. Willemssen3. 1Surgery, 2Medical Informatics, 3 Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands Rationale: Low skeletal muscle mass and density are predictive parameters to guide interventions in various populations, including cancer patients. The gold standard for body composition analysis in cancer patients is computed tomography (CT). To date, the effect of contrast-enhancement on muscle composition measurements has not been established. We sought to determine the effect of contrast-enhancement on skeletal muscle mass and density measurements on four-phase CT studies. Methods: In this observational study, two observers measured cross-sectional skeletal muscle area corrected for patients’ height (skeletal muscle index [SMI]) and density (SMD) at the level of the third lumbar vertebra on 50 randomly selected CTexaminations with both unenhanced, arterial, and portalvenous phases. The levels of agreement between enhancement
Disclosure of Interest: None declared.
SUN-P202 SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY
Rationale: Endoscopic Gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurological dysphagia and head or neck cancer are the main indications. Sodium, calcium, chlorine are extracellular electrolytes, while potassium, magnesium, phosphorus are mostly intracellular. Changes in serum electrolytes may have significant impact on metabolic balance. The aim of our study is to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. Methods: Prospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016 and who died using PEG. Serum electrolytes, albumin, transferrin and reactive C protein (RCP) were evaluated immediately before to the gastrostomy procedure. Survival was recorded in months after PEG until death. Results: We evaluated 92 patients, 51 with electrolyte alterations at the time of the gastrostomy. Sodium was altered in 28 (27.2%), magnesium in 18 (19.6%), chlorine in 17 (18.5%), potassium in 14 (15.2%), calcium and phosphorus in 9 (9.7%) each. The mean post-gastrostomy survival was 6.65 months. The survival of low sodium patients (<135 mmol/mL) was compared with patients with normal/high values. The survival was 2.76 months vs 7.80 months ( p = 0.007). There was also a negative correlation between survival and RCP (R = −0.22; p = 0.034). Conclusion: Changes in serum electrolytes of patients undergoing PEG are very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent is hyponatremia, which is associated with significantly shorter survival, probably reflecting severe systemic metabolic distress. The RCP reflects the inflammation. Higher RCP values are associated with lower survival. Disclosure of Interest: None declared.
Poster
people over 60 years old, but no formula is validated for use in African countries, including Benin. The purpose of this study was to compare height provided by predictive formulas using KH to measured height in an elderly population in Benin. Methods: People over 60 years of age in Benin underwent nutritional assessment with determination of weight, body mass index (BMI), height and KH. A Bland and Altman analysis was carried out by gender and age. The percentage of predictions accurate to ± 5cm compared to the measured height was calculated. The tested formulas were Chumlea’s formulas for non-Hispanic Black people (CBP) and two formulas for use among Caucasians (CC1, CC2). Results: Data from 396 subjects were analysed. The mean age was 66.6 ± 5.2 years and mean height of 165.4 ± 8.0 cm. The sex-ratio was of 4.3. The three formulas achieved 98.0% accuracy, but with 4.6% risk of error (±2 SD: −6 to +9 cm), which appeared to make them unfitted for the whole population. The predictions of the three formulas in the total population are presented in Table 1. Nevertheless, if a level of prediction ± 5 cm is considered acceptable in clinical practice, the CBP formula achieved 83.1% accuracy. Moreover, there was no significant difference in BMI calculated with the measured and the predicted height, and the nutritional status based on BMI did not differ.
phases for SMI and SMD were calculated using intra-class correlation coefficients (ICCs). Results: Mean SMI was 42.5 (±9.9) cm2/m2 on the unenhanced phase, compared with 42.8 (±9.9) and 43.6 (±9.9) cm2/m2 for the arterial and portal-venous phase, respectively (both p < 0.01). Mean SMD was lower for the unenhanced phase (30.9 ± 8.0 HU) compared with the arterial (38.0 ± 9.9 Hounsfield units [HU]) and portal-venous (38.7 ± 9.2 HU) phase (both p < 0.001). No significant difference was found between SMD in the portal-venous and arterial phase ( p = 0.161). The ICCs were excellent (≥0.992) for all SMIs and for SMD between the contrast-enhanced phases (0.949). The ICCs for the unenhanced phase compared with the arterial (0.676) and portal-venous (0.665) phase were considered fair to good. Conclusion: Statistically significant, but not clinically relevant differences were found in SMI between enhancement phases. Contrast-enhancement strongly influenced SMD values. Studies using this measure should therefore use the portal-venous phase of contrast-enhanced CT-examinations.
Table 1: Predictions of the three formulas studied.
J. Vieira1, G. Nunes1, C. A. Santos1 *, J. Fonseca1. 1Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
n = 396 CBP CC1 CC2
Acurate prediction (%)
Overestimation (+5 cm) (%)
Underestimation (−5 cm) (%)
83.1 80.3 78.5
12.4 15.9 18.2
4.5 3.8 3.3
Conclusion: CBP formulas seem applicable in 83% of cases (±5 cm) to assess the height with KH of older people in Benin and do not overestimate the prevalence of malnutrition. Disclosure of Interest: None declared.
SUN-P201 CONTRAST-ENHANCEMENT INFLUENCES SKELETAL MUSCLE DENSITY, BUT NOT SKELETAL MUSCLE MASS, MEASUREMENTS ON COMPUTED TOMOGRAPHY J. Van Vugt1 *, R. Coebergh van den Braak1, H.-J. Schippers1, K. Veen1, S. Levolger1, R. de Bruin1, M. Koek2, W. Niessen2, J. Ijzermans1, F. Willemssen3. 1Surgery, 2Medical Informatics, 3 Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands Rationale: Low skeletal muscle mass and density are predictive parameters to guide interventions in various populations, including cancer patients. The gold standard for body composition analysis in cancer patients is computed tomography (CT). To date, the effect of contrast-enhancement on muscle composition measurements has not been established. We sought to determine the effect of contrast-enhancement on skeletal muscle mass and density measurements on four-phase CT studies. Methods: In this observational study, two observers measured cross-sectional skeletal muscle area corrected for patients’ height (skeletal muscle index [SMI]) and density (SMD) at the level of the third lumbar vertebra on 50 randomly selected CTexaminations with both unenhanced, arterial, and portalvenous phases. The levels of agreement between enhancement
Disclosure of Interest: None declared.
SUN-P202 SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY
Rationale: Endoscopic Gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurological dysphagia and head or neck cancer are the main indications. Sodium, calcium, chlorine are extracellular electrolytes, while potassium, magnesium, phosphorus are mostly intracellular. Changes in serum electrolytes may have significant impact on metabolic balance. The aim of our study is to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. Methods: Prospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016 and who died using PEG. Serum electrolytes, albumin, transferrin and reactive C protein (RCP) were evaluated immediately before to the gastrostomy procedure. Survival was recorded in months after PEG until death. Results: We evaluated 92 patients, 51 with electrolyte alterations at the time of the gastrostomy. Sodium was altered in 28 (27.2%), magnesium in 18 (19.6%), chlorine in 17 (18.5%), potassium in 14 (15.2%), calcium and phosphorus in 9 (9.7%) each. The mean post-gastrostomy survival was 6.65 months. The survival of low sodium patients (<135 mmol/mL) was compared with patients with normal/high values. The survival was 2.76 months vs 7.80 months ( p = 0.007). There was also a negative correlation between survival and RCP (R = −0.22; p = 0.034). Conclusion: Changes in serum electrolytes of patients undergoing PEG are very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent is hyponatremia, which is associated with significantly shorter survival, probably reflecting severe systemic metabolic distress. The RCP reflects the inflammation. Higher RCP values are associated with lower survival. Disclosure of Interest: None declared.