The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis

Abstract

Background Patients with critical illness can lose more than 15% of muscle mass in one week, and this can have long-term detrimental effects. However, there is currently no synthesis of the data of intensive care unit (ICU) muscle wasting studies, so the true mean rate of muscle loss across all studies is unknown. The aim of this project was therefore to systematically synthetise data on the rate of muscle loss and to identify the methods used to measure muscle size and to synthetise data on the prevalence of ICU-acquired weakness in critically ill patients. Methods We conducted a systematic literature search of MEDLINE, PubMed, AMED, BNI, CINAHL, and EMCARE until January 2022 (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD420222989540. We included studies with at least 20 adult critically ill patients where the investigators measured a muscle mass-related variable at two time points during the ICU stay. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the Newcastle–Ottawa Scale. Results Fifty-two studies that included 3251 patients fulfilled the selection criteria. These studies investigated the rate of muscle wasting in 1773 (55%) patients and assessed ICU-acquired muscle weakness in 1478 (45%) patients. The methods used to assess muscle mass were ultrasound in 85% (n = 28/33) of the studies and computed tomography in the rest 15% (n = 5/33). During the first week of critical illness, patients lost every day −1.75% (95% CI −2.05, −1.45) of their rectus femoris thickness or −2.10% (95% CI −3.17, −1.02) of rectus femoris cross-sectional area. The overall prevalence of ICU-acquired weakness was 48% (95% CI 39%, 56%). Conclusion On average, critically ill patients lose nearly 2% of skeletal muscle per day during the first week of ICU admission.

Association of muscle wasting with mortality risk among adults: A systematic review and meta‐analysis of prospective studies

“…We defined muscle wasting as a loss of muscle mass due to aging or any underlying illness with or without decreases in muscle function or fat tissue wasting. [2][3][4] Based on previous studies, [22][23][24] we included studies that reported muscle mass loss of any severity under any definition criteria. The detailed information on cut-off points of muscle wasting for all included studies was presented in Table S2.…”

Mitochondrial involvement in sarcopenia

“…The underlying causes of sarcopenia include malnutrition, inactivity, and disease, as well as drugs and hospital admission 2 . Skeletal muscle quality is thus not only lost with old age (primary sarcopenia) but also in association with diseases such as cancer, 5 type 2 diabetes, 6 cardiovascular disease, 7 chronic obstructive pulmonary disease, 8 chronic kidney disease, 9 advanced liver disease, 10 as well as with acute and chronic critical illness 11 . Obesity is an important risk factor for these chronic disorders, and disease‐related secondary sarcopenia also occurs in individuals with excess body fat 12 .…”

The role of microRNAs in muscle wasting and recovery during critical illness: a systematic review

“…[1][2][3][4] These patients often experience muscle weakness contributing to ICU-acquired weakness (ICU-AW), which is associated with functional limitations, decreased independence and reduced quality of life. 4 Although there is no consensus on how to quantify muscle changes in critically ill patients, 5 ICU-AW is present in up to 75% of mechanically ventilated and critically ill patients, [6][7][8][9][10][11][12] and is more pronounced in older adults, owing to baseline weaker muscle including sarcopenia, 8,11,[13][14][15] frailty 16 and age-associated risk of adverse health outcomes. 17 Sepsis, COVID-19, systemic inflammation, sedation, mechanical ventilation, muscle paralysis and immobilization all contribute to the development of ICU-AW.…”