de Lellis Júlia Zeitum, Stamato Oliveira Fernanda Junqueira, Toloi Jerusa Márcia, de Oliveira Medeiros Izabela Augusta, Silva-Jr João Manoel
Barretos Cancer Hospital, R. Antenor Duarte Vilela, 1331, Dr. Paulo Prata, Barretos, SP, 14784-400, Brazil.
Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Sala 4107, São Paulo, SP, 01246-903, Brazil.
Clin Nutr ESPEN. 2025 Aug;68:160-167. doi: 10.1016/j.clnesp.2025.04.003. Epub 2025 Apr 30.
BACKGROUND & AIMS: Oncological patients frequently suffer from weight loss, reduced strength, and muscle mass depletion, negatively impacting prognosis and quality of life. This often necessitates intensive care unit (ICU) treatment, where muscle loss is further exacerbated, increasing the risk of sarcopenia. This study aimed to investigate the predictive performance of quadriceps ultrasound as an initial screening tool for reduced muscularity and sarcopenia risk in critically ill oncology patients, using computed tomography (CT) as the comparative standard.
In this prospective cohort study, patients admitted to an oncological intensive care unit (ICU) between March 2021 and February 2023 were included if they remained in the intensive care unit (ICU) for at least 24 h, had clear third lumbar vertebra (L3) visualization on computed tomography (CT), and provided informed consent. Patients were excluded if they were under palliative care, had amputations of the lower limbs, or had poor-quality computed tomography (CT) imaging that did not allow for accurate assessment. Quadriceps muscle thickness was assessed upon intensive care unit (ICU) admission using the VALIDUM method and compared with computed tomography (CT) findings.
A total of 88 patients were included (mean age 60.6 ± 13.0 years). The most effective method for assessing low muscle mass was ultrasound measurement at two-thirds of the thigh with compression, with a cutoff point of 1.29 cm, yielding a sensitivity of 73.21 % and specificity of 78.12 %. Significant associations were found between measurements below 1.29 cm and lower weight, body mass index (BMI), and skeletal muscle mass index.
Quadriceps ultrasound upon intensive care unit (ICU) admission is a reliable screening method for detecting low muscle mass in critically ill oncological patients, allowing for early intervention to address sarcopenia risk.
肿瘤患者常伴有体重减轻、力量下降和肌肉量减少，对预后和生活质量产生负面影响。这通常需要重症监护病房（ICU）治疗，而在ICU中肌肉流失会进一步加剧，增加了患肌肉减少症的风险。本研究旨在以计算机断层扫描（CT）作为对照标准，调查股四头肌超声作为重症肿瘤患者肌肉减少和肌肉减少症风险初始筛查工具的预测性能。
在这项前瞻性队列研究中，纳入2021年3月至2023年2月期间入住肿瘤重症监护病房（ICU）的患者，条件是他们在重症监护病房（ICU）至少停留24小时，在计算机断层扫描（CT）上能清晰看到第三腰椎（L3），并提供知情同意书。若患者处于姑息治疗状态、下肢截肢或计算机断层扫描（CT）成像质量差而无法进行准确评估，则将其排除。在重症监护病房（ICU）入院时使用VALIDUM方法评估股四头肌厚度，并与计算机断层扫描（CT）结果进行比较。
共纳入88例患者（平均年龄60.6±13.0岁）。评估低肌肉量最有效的方法是在大腿三分之二处加压进行超声测量，截断点为1.29厘米，灵敏度为73.21%，特异度为78.12%。发现低于1.29厘米的测量值与较低的体重、体重指数（BMI）和骨骼肌质量指数之间存在显著关联。
重症监护病房（ICU）入院时的股四头肌超声是检测重症肿瘤患者低肌肉量的可靠筛查方法，有助于早期干预以应对肌肉减少症风险。
