Skeletal muscle mass and adipose tissue alteration in critically ill patients

Abstract

Background Increasing numbers of studies in chronic diseases have been published showing the relationship between body composition (BC) parameters (i.e. skeletal muscle mass (SMM) and adipose tissue (AT)) and outcomes. For patients admitted to intensive care unit (ICU), BC parameters have rarely been described as a prognostic marker of outcome. The primary objective was to evaluate the relationship between body composition at ICU admission and major clinical outcomes. Secondary objectives were to assess the relationship between BC parameters and other parameters (systemic inflammatory markers, Sequential Organ Failure Assessment (SOFA) score, albumin level) at ICU admission, and between BC alterations during ICU stay and outcomes. Patients and methods This retrospective study enrolled 25 adult patients who had two abdominal CT scans for clinical indication: first, within 48 hours of ICU admission (initial assessment), and second, 7 to 14 days later (late assessment). Skeletal Muscle radiodensity (SMD), cross-sectional area of SMM, Visceral Adipose Tissue (VAT) and Subcutaneous Adipose Tissue (SAT) were measured at the third lumbar vertebra. Cox regression analysis was used to determine the association between these parameters and mortality. Results Patients’ mean age was 64.6 years. Their mean BMI was 27.7 kg/m 2 (SD = 6.0). ICU mortality was 36%. There was no correlation between BC parameters at initial assessment and ICU outcomes. We observed a negative correlation between SMM index and SOFA score at initial assessment (r = -0.458, p = 0.037). There was a significant loss of VAT between two CT assessments which was associated with mortality (-22.34cm 2 / m 2 in non-survivors versus -6.22 cm 2 / m 2 in survivors, p = 0.039). Loss of SMD was greater with the occurrence of an infection than without (Delta SMD = -5.642 vs +1.957, p = 0.04). Conclusions Our results show alterations in body composition during ICU stay with a loss of muscle quality (decreased SMD) and adipose tissue. These findings require confirmation in future studies but already show that BC assessments at ICU admission and BC alterations during ICU stay are important factors for outcome in critically ill patients.

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

“…Therefore, it is plausible that fat, and not muscle or bone, contributes to better prognosis. While a recent retrospective study involving 25 patients suggests that baseline body composition including fat and muscle is not associated with ICU length of stay [ 27 ], no evaluation of survival was reported and the small sample size of that cohort precluded analyses combining relevant covariables. Our data suggests that subcutaneous adipose tissue has no association with outcomes and that it is the contribution of muscle to body weight rather than fat or bone that is independently associated with survival.…”

Skeletal Muscle Depletion and Nutrition Support Affected Postoperative Complications in Patients Underwent Pancreatoduodenectomy

“…In aging and tumor patients, the muscle depletion may be caused by insu cient intake and ensuing proteolysis, which occurred long before admission. Study has shown the serum albumin concentration correlated well with skeletal mass in critical patients [27]. Decreased albumin always indicated poor nutrition status and even leaded to tissue edema, which may hamper surgical procedure and healing.…”

“…An inverse association between muscle attenuation and triglyceride content has been established in healthy adults [32], and it was shown IMAT correlated with muscle density [4]. Myosteatosis may involve insulin resistance, in ammation, mitochondrial damage and oxidative stress [27]. These metabolic changes would further cause a fuel utilization shift from lipids to glucose in muscle, leading to muscle protein depletion and reduced capacity [33].…”

Could Exogenous Insulin Ameliorate the Metabolic Dysfunction Induced by Glucocorticoids and COVID-19?

“…Negative nitrogen balance has been linked to detrimental clinical outcomes. The survival of critically-ill patients, their duration of ICU admission, and the duration to recovery of normal physiological function, are all inversely correlated with loss of lean body mass during hospitalisation (79). As the largest protein pool, it is unsurprising that the major site of protein loss is from skeletal muscle.…”