Division of Critical Care, AdventHealth Medical Group, AdventHealth Orlando, Florida.
Division of Nephrology and Hypertension.
Curr Opin Clin Nutr Metab Care. 2020 Sep;23(5):302-311. doi: 10.1097/MCO.0000000000000673.
Sarcopenia is a progressive generalized decline in skeletal muscle mass, strength, and function. This condition is highly prevalent in critically ill patients and is associated with poor outcomes in the ICU. In this review, we describe the use, evidence, and limitations of the most common validated imaging studies used to assess muscle mass in ICU, and we provide an overview of the benefits of using the sarcopenia index [(serum creatinine/serum cystatin C) × 100]) in the ICU.
Currently, the determination of muscle mass using anthropometric measurements and serum biomarkers is unreliable. Several new techniques, including a dual-energy X-ray absorptiometry, computed tomography scan, ultrasonography, and bioimpedance analysis, have been studied and validated for the diagnosis and prognosis of sarcopenia in the ICU. However, these techniques are often not accessible for the majority of critically ill patients. The sarcopenia index constitutes an accurate method to diagnose sarcopenia, predict ICU outcomes, and nutritional status in critically ill patients.
Diagnosis of sarcopenia has substantial implications in ICU patients. Choosing the correct test to identify patients who may need preventive or therapeutic support for this condition will favorably impact ICU outcomes.
肌肉减少症是一种骨骼肌质量、力量和功能进行性广泛下降的疾病。这种情况在重症患者中非常普遍,并与 ICU 预后不良相关。在这篇综述中,我们描述了最常用于评估 ICU 肌肉量的最常见验证成像研究的使用、证据和局限性,并概述了在 ICU 中使用肌少症指数[(血清肌酐/血清胱抑素 C)×100]的益处。
目前,使用人体测量和血清生物标志物来确定肌肉质量是不可靠的。已经研究并验证了几种新技术,包括双能 X 射线吸收法、计算机断层扫描、超声和生物阻抗分析,用于 ICU 中肌少症的诊断和预后。然而,这些技术通常不适用于大多数重症患者。肌少症指数是诊断肌少症、预测 ICU 结局和评估重症患者营养状况的准确方法。
在 ICU 患者中诊断肌少症具有重要意义。选择正确的测试来识别可能需要对此病症进行预防或治疗支持的患者,将有利于改善 ICU 结局。