Shen Yuehao, Li Linlin, Liu Haiying, Zhang Yue, Huang Dongxue, Duan Liuqing, Zhao Lina, Xie Keliang
Department of Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin 300052, China. Corresponding author: Xie Keliang, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2024 Nov;36(11):1196-1202. doi: 10.3760/cma.j.cn121430-20240819-00706.
To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).
A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m for males and less than 5.7 kg/m for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients was evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn.
Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio (OR) = 0.79, 95% confidence interval (95%CI) was 0.67-0.93, P = 0.004], calf circumference (OR = 0.64, 95%CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation (OR = 1.06, 95%CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95%CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test: χ = 5.619, P = 0.018).
Lower BMI, smaller calf circumference, and longer duration of mechanical ventilation are associated with an increased risk of sarcopenia in critically ill elderly patients.
调查和分析重症监护病房（ICU）老年危重症患者肌肉减少症的发生情况及影响因素。
进行一项前瞻性队列研究。纳入2023年11月至2024年6月入住天津医科大学总医院ICU的老年患者（年龄≥60岁）。收集临床记录，并进行肌肉质量和力量测量，同时测量上臂围和小腿围。男性四肢骨骼肌指数（ASMI）小于7.0kg/m²、女性小于5.7kg/m²定义为肌肉质量降低，男性握力小于28kg、女性小于18kg定义为肌肉力量下降，同时符合低肌肉质量和低肌肉力量标准的患者诊断为肌肉减少症。根据肌肉减少症诊断标准，将患者分为肌肉减少症组和非肌肉减少症组。应用多因素Logistic回归分析确定老年患者肌肉减少症的危险因素，并建立肌肉减少症发生的预测模型。通过受试者工作特征曲线（ROC曲线）评估各危险因素对老年危重症患者肌肉减少症的预测价值。绘制两组患者ICU住院时间的Kaplan-Meier曲线。
最终纳入540例老年危重症患者，其中肌肉减少症患者43例，肌肉减少症发生率为8.0%。单因素分析显示，肌肉减少症组与非肌肉减少症组在体重指数（BMI）、过去一年住院次数、ICU住院时间、通气模式、机械通气时间、入院前运动习惯、营养支持方式、上臂围、小腿围及白蛋白输注方面存在显著差异。多因素Logistic回归分析显示，BMI[比值比（OR）=0.79，95%置信区间（95%CI）为0.67 - 0.93，P = 0.004]、小腿围（OR = 0.64，95%CI为
