Rheumatology & Clinical Immunology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt.
Endocrinology, Metabolism and Clinical Nutrition Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Egypt.
Clin Nutr ESPEN. 2023 Jun;55:128-135. doi: 10.1016/j.clnesp.2023.02.023. Epub 2023 Mar 8.
Low skeletal muscle mass in ICU patients is associated with poor clinical outcome. Ultrasonography is a noninvasive method that can measure muscle thickness at the bedside. We aimed at studying the relation of the ultrasonography measured muscle layer thickness (MLT) at time of ICU admission with the patients' outcome namely mortality, duration of mechanical ventilation (MV) and ICU length of stay (LOS). In addition to define the best cut-off values that can predict mortality in medical ICU patients.
this observational prospective study was conducted on 454 adult critically ill patients admitted to the medical ICU of a university hospital. At the time of admission, MLT of the anterior mid-arm and lower 1/3 thigh were assessed using ultrasonography with and without transducer compression. The clinical scores for assessment of disease severity; Acute Physiology and Chronic Health Evaluation score (APACHE-II) and Sequential Organ Failure Assessment score (SOFA) in addition to nutrition risk; modified Nutrition Risk in Critically ill score (mNUTRIC) were estimated for all patients. ICU LOS, duration on MV and mortality were reported.
The mean age of our patients was 51 years ± 19. The ICU mortality rate was 36.56%. The baseline MLT was negatively associated with APACHE-II, SOFA and NUTRIC scores but not with duration of MV or ICU-LOS. The non-survivors had lower values of baseline MLT. A cut-off value of 0.895 cm (AUC: 0.649, 95% CI of 0.595-0.703) using the mid-arms as a reference point with maximum probe compression showed the highest sensitivity (90%) to predict mortality compared to other techniques however with low specificity (22%).
the baseline ultrasonography measured mid-arm MLT is a sensitive risk assessment tool that can reflect disease severity and predict ICU mortality.
ICU 患者的骨骼肌量低与临床预后不良有关。超声检查是一种可以在床边测量肌肉厚度的非侵入性方法。我们旨在研究 ICU 入院时超声测量的肌肉层厚度（MLT）与患者预后（即死亡率、机械通气（MV）持续时间和 ICU 住院时间（LOS））之间的关系。此外，确定可预测内科 ICU 患者死亡率的最佳截断值。
这项观察性前瞻性研究在一家大学医院的内科 ICU 收治的 454 名成年危重症患者中进行。在入院时，使用超声测量前中臂和大腿下部 1/3 处的 MLT，并进行探头加压和不加压两种情况下的测量。对所有患者进行疾病严重程度评估的临床评分；急性生理学和慢性健康评估评分（APACHE-II）和序贯器官衰竭评估评分（SOFA），以及营养风险评估；改良重症患者营养风险评分（mNUTRIC）。报告 ICU 住院时间、MV 持续时间和死亡率。
患者的平均年龄为 51 岁±19 岁。ICU 死亡率为 36.56%。基线 MLT 与 APACHE-II、SOFA 和 NUTRIC 评分呈负相关，但与 MV 持续时间或 ICU-LOS 无关。存活组和非存活组的基线 MLT 值较低。使用最大探头加压时，以中臂为参考点的 0.895cm 截断值（AUC：0.649，95%CI：0.595-0.703）显示出预测死亡率的最高敏感性（90%），但特异性（22%）较低。
基线超声测量的中臂 MLT 是一种敏感的风险评估工具，可反映疾病严重程度并预测 ICU 死亡率。
