Umbrello Michele, Formenti Paolo, Artale Alessandro, Assandri Maddalena, Palandri Chiara, Ponti Silvia, Venco Roberto, Waccher Giulia, Muttini Stefano
From the SC Rianimazione e Anestesia, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Legnano, Italy.
SC Anestesia, Rianimazione e Terapia Intensiva, Ospedale E. Bassini, ASST Nord Milano, Cinisello Balsamo, Italy.
Anesth Analg. 2025 Feb 1;140(2):427-436. doi: 10.1213/ANE.0000000000007035. Epub 2025 Jan 10.
Computed tomography (CT)-derived low muscle mass is associated with adverse outcomes in critically ill patients. Muscle ultrasound is a promising strategy for quantitating muscle mass. We evaluated the association between baseline ultrasound rectus femoris cross-sectional area (RF-CSA) and intensive care unit (ICU) mortality. Secondary outcomes were the determinants of RF-CSA, and the diagnostic performance of RF-CSA after adjustment for body size.
A prospective, single-center, observational cohort study was conducted in 3 ICUs (general, neuroscience, coronavirus disease-2019 [COVID-19]) of a university-affiliated hospital. Consecutive, mechanically ventilated patients with predicted length of stay >72 hours were included. RF-CSA was assessed at the dominant leg by ultrasound. Association with ICU mortality was tested using multivariable logistic regression. Diagnostic performance of RF-CSA was compared after adjustment by sex (CSA-sex), body surface area (CSA-BSA), and squared height (CSA-H2).
A total of 316 patients were enrolled: age 69 [60-76], 211 men and 183 ICU survivors. Older age (odds ratio, OR [95% confidence interval, CI], 1.03 [1.01-1.05]), the type of ICU (neuroscience: 0.82 [0.38-1.79], COVID-19: 4.1 [2.01-8.38]), a higher modified Nutrition and Rehabilitation Investigators Consortium (NUTRIC) score (1.43 [1.21-1.70]), and a lower RF-CSA (0.41 [0.29-0.58]) were associated with ICU mortality. Baseline RF-CSA was lower in women, with higher nutritional risk, older age, and larger body size. Unadjusted RF-CSA had an area under the receiver operating characteristic (ROC) curve for ICU mortality of 0.720 [0.663-0.776], and this value was not significantly different from that of CSA-sex, CSA-BSA, and CSA-H2 (P = .1487).
Low baseline RF-CSA was associated with increased ICU mortality. Admission RF-CSA was lower in women, with high nutritional risk, in older subjects and with lower body size. Absolute muscle mass was significantly associated with mortality, with no significant increase in this relationship when adjusting for sex or body size.
计算机断层扫描（CT）得出的低肌肉量与危重症患者的不良预后相关。肌肉超声是一种有前景的肌肉量定量方法。我们评估了基线超声股直肌横截面积（RF-CSA）与重症监护病房（ICU）死亡率之间的关联。次要结局是RF-CSA的决定因素，以及调整身体大小后RF-CSA的诊断性能。
在一家大学附属医院的3个ICU（综合、神经科学、2019冠状病毒病[COVID-19]）中进行了一项前瞻性、单中心、观察性队列研究。纳入预计住院时间>72小时的连续机械通气患者。通过超声评估优势腿的RF-CSA。使用多变量逻辑回归测试与ICU死亡率的关联。在按性别（CSA-性别）、体表面积（CSA-BSA）和身高平方（CSA-H2）进行调整后，比较RF-CSA的诊断性能。
共纳入316例患者：年龄69岁[60-76岁]，211例男性，183例ICU幸存者。年龄较大（比值比，OR[95%置信区间，CI]，1.03[1.01-1.05]）、ICU类型（神经科学：0.82[0.38-1.79]，COVID-19：4.1[2.01-8.38]）、改良营养与康复研究人员联盟（NUTRIC）评分较高（1.43[1.21-1.70]）以及RF-CSA较低（0.41[0.29-0.58]）与ICU死亡率相关。女性、营养风险较高、年龄较大和体型较大者的基线RF-CSA较低。未调整的RF-CSA用于ICU死亡率的受试者工作特征（ROC）曲线下面积为0.720[0.663-0.776]，该值与CSA-性别、CSA-BSA和CSA-H2的值无显著差异（P = 0.1487）。
低基线RF-CSA与ICU死亡率增加相关。女性、营养风险高、年龄较大和体型较小者入院时的RF-CSA较低。绝对肌肉量与死亡率显著相关，在调整性别或身体大小后这种关系无显著增加。
