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Cited by 218Nutrition and Health in AgingIntensive Care Unit Cognitive DisordersClinical Nutrition and Gastroenterology

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Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients

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Looijaard, Wilhelmus G. P. M., Dekker, Ingeborg M., Stapel, Sandra N., Girbes, Armand R. J., Twisk, Jos W. R., Oudemans-van Straaten, Heleen M., Weijs, Peter J. M.·2016·Critical Care
DOI 10.1186/s13054-016-1563-3PMC PMC5131531
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Abstract

BACKGROUND: Muscle quantity at intensive care unit (ICU) admission has been independently associated with mortality. In addition to quantity, muscle quality may be important for survival. Muscle quality is influenced by fatty infiltration or myosteatosis, which can be assessed on computed tomography (CT) scans by analysing skeletal muscle density (SMD) and the amount of intermuscular adipose tissue (IMAT). We investigated whether CT-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes. METHODS: This retrospective study included 491 mechanically ventilated critically ill adult patients with a CT scan of the abdomen made 1 day before to 4 days after ICU admission. Cox regression analysis was used to determine the association between SMD or IMAT and 6-month mortality, with adjustments for Acute Physiological, Age, and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and skeletal muscle area. Logistic and linear regression analyses were used for other clinical outcomes. RESULTS: ; p = 0.004). Higher SMD was associated with a lower 6-month mortality (hazard ratio (HR) per 10 HU, 0.640; 95% confidence interval (CI), 0.552-0.742; p < 0.001), and also after correction for APACHE II score, BMI, and skeletal muscle area (HR, 0.774; 95% CI, 0.643-0.931; p = 0.006). Higher IMAT was not significantly associated with higher 6-month mortality after adjustment for confounders. A 10 HU increase in SMD was associated with a 14% shorter hospital length of stay. CONCLUSIONS: Low skeletal muscle quality at ICU admission, as assessed by CT-derived skeletal muscle density, is independently associated with higher 6-month mortality in mechanically ventilated patients. Thus, muscle quality as well as muscle quantity are prognostic factors in the ICU. TRIAL REGISTRATION: Retrospectively registered (initial release on 06/23/2016) at ClinicalTrials.gov: NCT02817646 .

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Fig. 1 Example of CT scan analysis. This image shows CT scans at the level of lumbar vertebra 3 of two patients both un-analysed (upper row) and analysed (lower row). The analysed images show muscle tissue (red) and intermuscular adipose tissue (IMAT, green). The patient on the left has more muscle (165 vs. 120 cm2), less IMAT (10 vs. 19.5 cm2), and higher mean skeletal muscle density (42 vs. 18 Hounsfield Units) than the patient on the right
Fig. 1 Example of CT scan analysis. This image shows CT scans at the level of lumbar vertebra 3 of two patients both un-analysed (upper row) and analysed (lower row). The analysed images show muscle tissue (red) and intermuscular adipose tissue (IMAT, green). The patient on the left has more muscle (165 vs. 120 cm2), less IMAT (10 vs. 19.5 cm2), and higher mean skeletal muscle density (42 vs. 18 Hounsfield Units) than the patient on the rightCC BY · PubMed Central
Fig. 2 Consort diagram showing the inclusion process. CT computed tomography, ICU intensive care unit
Fig. 2 Consort diagram showing the inclusion process. CT computed tomography, ICU intensive care unitCC BY · PubMed Central
Fig. 3 Kaplan-Meier plots. These graphs illustrate mortality for groups below and above median skeletal muscle density (SMD) (29.2 Hounsfield Units) and median intermuscular adipose tissue (IMAT) (13.6 cm2). ICU intensive care unit
Fig. 3 Kaplan-Meier plots. These graphs illustrate mortality for groups below and above median skeletal muscle density (SMD) (29.2 Hounsfield Units) and median intermuscular adipose tissue (IMAT) (13.6 cm2). ICU intensive care unitCC BY · PubMed Central

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Authors
Looijaard, W. G. P. M., Dekker, I. M., Stapel, S. N., Girbes, A. R. J., Twisk, J. W. R., Oudemans-van Straaten, H. M., & Weijs, P. J. M.
Affiliations
  • Amsterdam Cardiovascular Sciences (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • Amsterdam University of Applied Sciences (NL)
Corresponding author
Looijaard, Wilhelmus G. P. M.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2016-12
Volume
20
Issue
1
Pages
386-386
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-016-1563-3
PMC
PMC5131531
OpenAlex
W2556942267
Cited by
218
References
44
Citations by year
2026: 13 · 2025: 28 · 2024: 22 · 2023: 26 · 2022: 28 · 2021: 31 · 2020: 22 · 2019: 23 · 2018: 18 · 2017: 7
FWCI
12.87
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Critical Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Baxter Healthcare Corporation (US) (Research grant GHOL6290)
Topics
  • Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
skeletal muscle quality, skeletal muscle density, intermuscular adipose tissue, myosteatosis, critically ill patients, mechanical ventilation, 6-month mortality, prognostic factors, length of hospital stay, intensive care unit admission
MeSH terms
Adult, Aged, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Respiration, Artificial, Retrospective Studies, Tomography, X-Ray Computed, Proportional Hazards Models, Critical Illness, Muscle, Skeletal, Statistics, Nonparametric, APACHE, Abdominal Wall

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