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Comment & Response |

Acute Muscle Wasting Among Critically Ill Patients—Reply

Zudin A. Puthucheary, MRCP1; Mark J. W. McPhail, MRCP, PhD2; Nicholas Hart, BSc, MRCP, PhD, FFICM3
[+] Author Affiliations
1Institute of Health and Human Performance, University College London, London, England
2Department of Hepatology and Gastroenterology, Imperial College London, London, England
3Lane Fox Respiratory Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, England
JAMA. 2014;311(6):622-623. doi:10.1001/jama.2013.285426.
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In Reply The inverse relationship found in our study between protein delivery and muscle wasting was hypothesis generating. Both Dr Heyland and colleagues and Mr Day were concerned that ICU length of stay may have been a confounding variable.

We prespecified an ICU length of stay of greater than 7 days as one of the inclusion criteria, with the primary end point (muscle loss) measured at day 10. Only 7 patients had an ICU length of stay between 7 and 10 days. The areas under the curve for cumulative organ failures over 7 days and 10 days were highly correlated (Figure). Therefore, we were justified in our use of area under the curve over this time frame.

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Correlation Between Area Under the Curve (AUC) of Organ Failures Over 7 Days and 10 Days (n = 63)

The linear regression of AUC of cumulative organs failed over 10 days (y axis) vs AUC for cumulative organs failed over 7 days (x axis); AUC for 10 days of 1.3859 (95% CI, 1.299-1.473) × AUC for 7 days of 1.446.

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February 12, 2014
Daren Heyland, MD; Carrie Earthman, PhD, RD; Charlene Compher, PhD, RD
1Clinical Evaluation Research Unit, Kingston, Ontario, Canada
2Department of Food Science and Nutrition, University of Minnesota, Minneapolis
3University of Pennsylvania School of Nursing, Philadelphia
JAMA. 2014;311(6):621-622. doi:10.1001/jama.2013.285420.
February 12, 2014
Andrew G. Day, MSc
1Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada
JAMA. 2014;311(6):622. doi:10.1001/jama.2013.285423.
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