ICU Admission Muscle and Fat Mass, Survival, and Disability at Discharge

Jaitovich, Ariel; Khan, Malik; Itty, Ria; Chieng, Hau; Dumas, Camille; Nadendla, Pallavi; Fantauzzi, John; Yucel, Recai; Feustel, Paul J.; Judson, Marc A.

doi:10.1016/j.chest.2018.10.023

Cited by 55 publications

(57 citation statements)

References 48 publications

(60 reference statements)

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“…Baseline frailty is associated with a higher risk of death and long-term disability after critical illness, 12,13 possibly because of diminished physiological reserve and reduced axial skeletal muscle mass and strength (sarcopenia). [2][3][4][5]14,15 The association between premorbid diaphragm muscle mass and the outcomes of critical illness is unknown. Diaphragm muscle mass varies widely in the general population [16][17][18] ; reduced diaphragm muscle mass has been documented in a variety of neuromuscular conditions.…”

Section: Introductionmentioning

confidence: 99%

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

et al. 2020

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IMPORTANCE Low diaphragm muscle mass at the outset of mechanical ventilation may predispose critically ill patients to poor clinical outcomes. OBJECTIVE To determine whether lower baseline diaphragm thickness (Tdi) is associated with delayed liberation from mechanical ventilation and complications of acute respiratory failure (reintubation, tracheostomy, prolonged ventilation >14 days, or death in the hospital).

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Section: Introductionmentioning

confidence: 99%

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

et al. 2020

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“…In the present study, we extended our prior study [ 8 ] by analyzing the association of erector spinae muscle, fat mass, and bone density determined within 24 h of ICU admission with survival and disability at hospital discharge. We chose to measure the antigravity erector spinae muscle (ESM) area given that it is indispensable for upright posture and locomotion, and thus could be associated with both outcome measures, and specifically clarify the association of muscle mass with disability at hospital discharge.…”

Section: Introductionmentioning

confidence: 92%

“…Skeletal muscle dysfunction, encompassing wasting and weakness [ 1 , 2 ], is associated with poor intensive care unit (ICU) outcomes including worse survival [ 3 ], need for mechanical ventilation, and higher readmission rate [ 4 – 6 ]. In many ICU survivors, muscle dysfunction persists for years [ 6 , 7 ], and we have recently reported that reduced pectoralis muscle mass at the time of ICU admission is independently associated with higher mortality during and after ICU care [ 8 ]. Even though functional capacity is highly influenced by muscle work, our data showed that admission muscle mass was not significantly associated with disability at hospital discharge [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…In many ICU survivors, muscle dysfunction persists for years [ 6 , 7 ], and we have recently reported that reduced pectoralis muscle mass at the time of ICU admission is independently associated with higher mortality during and after ICU care [ 8 ]. Even though functional capacity is highly influenced by muscle work, our data showed that admission muscle mass was not significantly associated with disability at hospital discharge [ 8 ]. Moreover, while muscle mass substantially contributes to normal body weight [ 9 ], the overweight state is largely driven by fat mass [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there is controversy as to whether obese-range weight paradoxically portends a better ICU prognosis [ 11 – 13 ] or not [ 14 – 16 ]. Our previous data indicated that subcutaneous fat mass at the 7th vertebral level measured at ICU admission was not significantly associated with ICU outcomes [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study

et al. 2020

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Background Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density. Methods Single-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders. Results Larger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity. Conclusion In our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures.

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Reference values of skeletal muscle area for diagnosis of sarcopenia using chest computed tomography in Asian general population

Moon

Lee

Woo

et al. 2022

J cachexia sarcopenia muscle

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Background Diagnostic cutoff points for sarcopenia in chest computed tomography (CT) have not been established although CT is widely used for investigating skeletal muscles. This study aimed to determine reference values for sarcopenia of thoracic skeletal muscles acquired from chest CT scans and to analyse variables related to sarcopenia using the cutoff values determined in a general Asian population. Methods We retrospectively reviewed chest CT scans of 4470 participants (mean age 54.8 ± 9.9 years, 65.8% male) performed at a check‐up centre in South Korea (January 2016–August 2017). To determine cutoffs, 335 participants aged 19–39 years (mean age 35.2 ± 3.6 years, 75.2% male) were selected as the healthy and younger reference group, and 4135 participants aged ≥40 years (mean age 56.4 ± 8.4 years, 65.1% male) were selected as the study group. We measured the following: cross‐sectional area (CSA) of the pectoralis, intercostalis, paraspinal, serratus, and latissimus muscles at the 4th vertebral region (T4CSA); T4CSA divided by height2 (T4MI); pectoralis muscle area (PMCSA); and PMCSA divided by height2 (PMI) at the 4th vertebral region. Sarcopenia cutoff was defined as sex‐specific values of less than −2 SD below the mean from the reference group. Results In the reference group, T4CSA, T4MI, PMCSA, and PMI cutoffs for sarcopenia were 100.06cm2, 33.69cm2/m2, 29.00cm2, and 10.17cm2/m2 in male, and 66.93cm2, 26.01cm2/m2, 18.29cm2, and 7.31cm2/m2 in female, respectively. The prevalence of sarcopenia in the study group measured with T4CSA, T4MI, PMCSA and PMI cutoffs were 11.4%, 8.7%, 8.5%, and 10.1%, respectively. Correlations were observed between appendicular skeletal mass divided by height2 measured by bioelectrical impedance analysis (BIA) and T4CSA (r = 0.82; P < 0.001)/T4MI (r = 0.68; P < 0.001), and ASM/height2 measured by BIA and PMCSA (r = 0.72; P < 0.001)/PMI (r = 0.63; P < 0.001). In the multivariate logistic regression models, sarcopenia defined by T4CSA/T4MI were related to age [odds ratio (95% confidence interval), P‐values: 1.09 (1.07–1.11), <0.001/1.05 (1.04–1.07), <0.001] and diabetes [1.60 (1.14–2.25), 0.007/1.47 (1.01–2.14), 0.043]. Sarcopenia defined by PMCSA/PMI were related to age [1.09 (1.08–1.10), <0.001/1.05 (1.03–1.06), <0.001], male sex [0.23 (0.18–0.30), <0.001/0.47 (0.32–0.71), <0.001], diabetes [2.30 (1.73–3.05), <0.001/1.63 (1.15–2.32), 0.007], history of cancer [2.51 (1.78–3.55), <0.001/1.61 (1.04–2.48), 0.033], and sufficient physical activity [0.67 (0.50–0.89), 0.007/0.74 (0.56–0.99), 0.042]. Conclusions The reference cutoff values of a general population reported here will enable sex‐specific standardization of thoracic muscle mass quantification and sarcopenia assessment.

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ICU Admission Muscle and Fat Mass, Survival, and Disability at Discharge

Cited by 55 publications

References 48 publications

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

Association of Low Baseline Diaphragm Muscle Mass With Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults

ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge—a prospective, cohort study

Reference values of skeletal muscle area for diagnosis of sarcopenia using chest computed tomography in Asian general population

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