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

Abstract

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.

Nutritional risk and clinical outcomes in critically ill adult patients with COVID-19

“…The main finding of our study was that malnutrition as assessed with SGA, and risk of malnutrition as assessed with the NRS-several other works, we showed that ICU patients with malnutrition have the worst outcome (11,12). Also, sarcopenic patients have the worst outcome in the ICU (13)(14)(15)(16)(17)(18)(19). But this work is the first one assessing nutritional risk and malnutrition in COVID-19 patients.…”

Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness

“…First, this was a single-center observational study, and the design precluded the determination of a causal association between sarcopenia in the ICU and 1-year mortality. Second, the study population was smaller than that in previous studies [ 6 , 10 , 11 ]. Based on the results obtained, we believe it is necessary to replicate the study on larger sample sizes in the future.…”

“…Skeletal muscle wasting and the development of intensive care unit-acquired weakness (ICU-AW) dramatically affect mortality and mobility disability after ICU discharge [ 1 , 2 , 3 ]. Moreover, skeletal muscle mass at ICU admission has been associated with mortality [ 4 , 5 , 6 ]. Thus, the value of assessing skeletal muscle mass and function in ICU patients has been emphasized in recent years [ 7 ].…”

Rectus Femoris Mimicking Ultrasound Phantom for Muscle Mass Assessment: Design, Research, and Training Application

“…Skeletal muscle is important to surviving critical illnesses [ 1 ]. At the intensive care unit (ICU) admission, higher muscle mass is associated with decreased mortality [ 2 ]. After the ICU admission, progressive muscle atrophy occurs, and the atrophy is associated with ICU acquired weakness and mortality [ 3 ].…”