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Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients
Open accessAbstract
Objectives: Parameters of patients’ body composition have been suggested as prognostic markers in several clinical conditions including cancer and liver transplantation, but only limited data on its value in critical illness exist to date. In this study, we aimed at evaluating a potential prognostic value of the skeletal muscle mass and skeletal muscle myosteatosis of critically ill patients at admission to the ICU. Design: Exploratory observational cohort study. Setting: An urban, academic medical institution. Patients: One-hundred fifty-five patients treated for critical illness on a medical ICU. Interventions: None. Measurements and Main Results: We used routine CT scans to assess the patients’ individual body composition. The skeletal muscle index as a surrogate for sarcopenia was defined as the total skeletal muscle area at the level of the third lumbar vertebra on axial CT scan, normalized for the patient’s height. Myosteatosis was evaluated by assessing the mean skeletal muscle attenuation measured in Hounsfield unit at the same sectional plane. The skeletal muscle index and mean skeletal muscle attenuation at admission to the ICU were significantly higher in patients with long-term survival (180-day or 1-year mortality), while both parameters were comparable between short-term survivors and nonsurvivors (ICU mortality or 30-d mortality). Patients with a skeletal muscle index or mean skeletal muscle attenuation below our established ideal cutoff values (74.95 mm 2/cm and 29 Hounsfield unit) showed a significantly reduced overall survival. These findings were confirmed in univariate and multivariate Cox regression analyses. Furthermore, myosteatosis significantly correlated with the time of mechanical ventilation, the duration of hospital stay, and the presence of sepsis. Conclusions: Our data suggest that sarcopenia and myosteatosis represent important prognostic factors in critically ill patients that can be easily obtained from routine CT scans. Both parameters at admission to the ICU yield important information on the patients’ long-term outcome and might be used for early clinical decision-making in these patients.
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Reported associations indicate a stronger link of muscle fat with adverse outcomes as compared with muscle quantity.
“reported associations indicate a stronger link of muscle fat with adverse outcomes as compared with muscle quantity.60,61,[65][66][67]”
From Changes in lean body mass with glucagon‐like peptide ‐1‐based therapies and mitigation strategies (2024) · cites this paper as [67]
In the Results section on overall survival (page not provided), muscle fat deposition was associated with longer ventilation and hospital stays and with sepsis, while muscle quantity was not. But the paper does not establish a generally stronger link between muscle fat and adverse outcomes: both measures predicted survival, and the reported survival hazard ratio was higher for low muscle quantity (1.850) than for greater fat deposition (1.690). (LLM, conf=0.86)
Experimental — accuracy not yet measuredA combined assessment of muscle quantity and muscle fat provides a more complete description of muscle health that has been shown to improve performance in identifying high-risk individuals.
“Therefore, a combined assessment provides a more complete description of muscle health that has been shown to improve the performance in identifying high-risk individuals. [58][59]59][60][61]65,67,69”
From Changes in lean body mass with glucagon‐like peptide ‐1‐based therapies and mitigation strategies (2024) · cites this paper as [67]
The Discussion reports that combining the muscle-quantity measure L3SMI with the muscle-fat measure MMA increased prognostic potential compared with either marker alone. The study tested this in critically ill ICU patients, so it does not establish improved identification of high-risk individuals more generally. (LLM, conf=0.85)
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“The latter is defined as the “progressive loss of muscle mass and strength with a risk of adverse outcomes such as disability, poor quality of life and death” by the Special Interest Group of the European Sarcopenia Working Group in 2010 (4).”
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Changes in lean body mass with glucagon‐like peptide ‐1‐based therapies and mitigation strategies
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Adverse muscle composition predicts all‐cause mortality in the UK Biobank imaging study
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Adverse muscle composition is a significant risk factor for all-cause mortality in NAFLD
Linge, J., Nasr, P., Sanyal, A. J., Dahlqvist Leinhard, O., & Ekstedt, M. (2023) · JHEP Reports · doi:10.1016/j.jhepr.2022.100663 · Cited by 42
Metadata
- Authors
- Loosen, S. H., Schulze-Hagen, M., Püngel, T., Bündgens, L., Wirtz, T., Kather, J. N., Vucur, M., Paffenholz, P., Demir, M., Bruners, P., Kuhl, C., Trautwein, C., Tacke, F., Luedde, T., Koch, A., & Roderburg, C.
- Affiliations
- Düsseldorf University Hospital (DE)
- Universitätsklinikum Aachen (DE)
- Department of Medicine III, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
- University Hospital Cologne (DE)
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Roderburg, Christoph
- ORCID
- Venue
- Critical Care Explorations
- Published
- 2020-08
- Volume
- 2
- Issue
- 8
- Pages
- e0171
- ISSN
- 2639-8028 (ISSN-L)
- PMC
- PMC7418902
- OpenAlex
- W3047626862
- Cited by
- 58
- References
- 4
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 13 · 2023: 11 · 2022: 10 · 2021: 13 · 2020: 1
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Critical Care Explorations (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Keywords
- skeletal muscle mass, myosteatosis, sarcopenia, body composition, prognostic factors, critically ill patients, ICU mortality, long-term survival, skeletal muscle index, sepsis, mechanical ventilation duration
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