Online citations, reference lists, and bibliographies.
← Back to Search

Low Skeletal Muscle Area Is A Risk Factor For Mortality In Mechanically Ventilated Critically Ill Patients

P. Weijs, W. G. Looijaard, I. Dekker, S. N. Stapel, A. Girbes, H. O. Straaten, A. Beishuizen
Published 2014 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
IntroductionHigher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship.MethodsThis retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1 day before and 4 days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110 cm2 for females and 170 cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables.ResultsThis study included 240 patients, 94 female and 146 male patients. Mean age was 57 years; mean BMI, 25.6 kg/m2. Muscle area for females was significantly lower than that for males (102 ± 23 cm2 versus 158 ± 33 cm2; P < 0.001). Low-muscle area was observed in 63% of patients for both females and males. Mortality was 29%, significantly higher in females than in males (37% versus 23%; P = 0.028). Low-muscle area was associated with higher mortality compared with normal-muscle area in females (47.5% versus 20%; P = 0.008) and in males (32.3% versus 7.5%; P < 0.001). Independent predictive factors for mortality were low-muscle area, sex, and APACHE II score, whereas BMI and admission diagnosis were not. Odds ratio for low-muscle area was 4.3 (95% confidence interval, 2.0 to 9.0, P < 0.001). When applying sex-specific cutoffs to all patients, muscle mass appeared as primary predictor, not sex.ConclusionsLow skeletal muscle area, as assessed by CT scan during the early stage of critical illness, is a risk factor for mortality in mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for.
This paper references
Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography.
N. Mitsiopoulos (1998)
Computerized energy balance and complications in critically ill patients: an observational study.
D. Dvir (2006)
Exploitation of diagnostic computed tomography scans to assess the impact of nutrition support on body composition changes in respiratory failure patients.
C. Braunschweig (2014)
Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.
C. Prado (2008)
Measurement of the thickness of the adductor pollicis muscle as a predictor of outcome in critically ill patients.
F. S. Caporossi (2012)
Human body composition: advances in models and methods.
S. Heymsfield (1997)
Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.
T. Rice (2012)
Female Gender Is an Independent Predictor of Operative Mortality After Coronary Artery Bypass Graft Surgery: Contemporary Analysis of 31 Midwestern Hospitals
R. Blankstein (2005)
Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.
Stéphane Villet (2005)
Acute skeletal muscle wasting in critical illness.
Z. Puthucheary (2013)
The impact of obesity on outcomes after critical illness: a meta-analysis
C. Hogue (2009)
Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer.
W. Gruther (2008)
Obesity: preventing and managing the global epidemic. Report of a WHO consultation.
Who Consultation on Obesity (2000)
Obesity and Mortality in Critically Ill Adults: A Systematic Review and Meta‐analysis
H. Oliveros (2008)
Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients (EPaNIC trial): a study protocol and statistical analysis plan for a randomized controlled trial
M. Casaer (2011)
The outcomes of obese patients in critical care.
L. Kiraly (2011)
Mortality prediction by surrogates of body composition: an examination of the obesity paradox in hemodialysis patients using composite ranking score analysis.
K. Kalantar-Zadeh (2012)
VE: Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index
L Martin (2013)
Optimal protein requirements during the first 2 weeks after the onset of critical illness.
N. Ishibashi (1998)
Optimizing energy and protein balance in the ICU
P. Weijs (2013)
Being overweight or obese is associated with decreased mortality in critically ill patients: a retrospective analysis of a large regional Italian multicenter cohort.
Y. Sakr (2012)
Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients
L. Moisey (2013)
Supplementation in Acute Lung Injury—Reply
T. Rice (2012)
Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients
Weijs (2014)
Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis.
V. Baracos (2010)
Body Mass Index Is Associated With Hospital Mortality in Critically Ill Patients: An Observational Cohort Study
P. Pickkers (2013)
Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study.
P. Weijs (2012)
The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients.
M. Visser (2012)
Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image.
Wei Shen (2004)
Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index.
L. Martin (2013)
Gender impact on the outcomes of critically ill patients with nosocomial infections*
A. Combes (2009)
Nutritional status, cachexia and survival in patients with advanced colorectal carcinoma. Different assessment criteria for nutritional status provide unequal results.
L. Thoresen (2013)
The outcomes of obese patients in critical care
L Kiraly (2011)
Validity of predictive equations for resting energy expenditure in Belgian normal weight to morbid obese women.
P. Weijs (2010)
Optimal nutrition during the period of mechanical ventilation decreases mortality in critically ill, long-term acute female patients: a prospective observational cohort study
R. J. M. Strack van Schijndel (2009)
Protein recommendations in the ICU: g protein/kg body weight - which body weight for underweight and obese patients?
P. Weijs (2012)
BAJM: The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients
M Visser (2012)
A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care.
M. Mourtzakis (2008)
R12 Page 7 of 7
Weijs (2014)
Extreme obesity and outcomes in critically ill patients.
J. Martino (2011)

This paper is referenced by
Clinically Practical Approach for Screening of Low Muscularity Using Electronic Linear Measures on Computed Tomography Images in Critically Ill Patients
Egor Avrutin (2018)
Urinary creatinine excretion is related to short-term and long-term mortality in critically ill patients
L. Hessels (2018)
Route, early or energy? … Protein improves protein balance in critically ill patients
P. Weijs (2018)
Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study
N. Denneman (2020)
Artificial Intelligence in the Evaluation of Body Composition.
B. Wang (2020)
Pérdida de masa muscular en el paciente críticamente enfermo: ¿Caquexia, sarcopenia y/o atrofia? Impacto en la respuesta terapéutica y la supervivencia
S. Chapela (2018)
Skeletal Muscle Index at Intensive Care Unit Admission Is a Predictor of Intensive Care Unit-Acquired Weakness in Patients With Sepsis
Y. Mitobe (2019)
Role of Nutrition Support in Inflammatory Conditions
O. Lheureux (2017)
Exploring the Potential Effectiveness of Combining Optimal Nutrition With Electrical Stimulation to Maintain Muscle Health in Critical Illness: A Narrative Review
S. Parry (2018)
Body composition analysis for discrimination of prolonged hospital stay in colorectal cancer surgery patients
G. Tsaousi (2017)
Ultrasound Measurement of Septic Shock-induced Acute Skeletal Muscle Atrophy in Intensive Care Unit.
Kohei Tanaka (2020)
One Week of Bed Rest Leads to Substantial Muscle Atrophy and Induces Whole-Body Insulin Resistance in the Absence of Skeletal Muscle Lipid Accumulation
Marlou L Dirks (2016)
Early Detection of Muscle Weakness and Functional Limitations in the Critically Ill: A Retrospective Evaluation of Bioimpedance Spectroscopy.
C. Baldwin (2019)
Reply to L.E. Daly et al
S. Blauwhoff-Buskermolen (2016)
Aerobic exercise increases post-exercise exogenous protein oxidation in healthy young males
G. Reckman (2019)
Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function.
S. Parry (2015)
Evaluación muscular respiratoria y periférica en la Unidad de Cuidados Intensivos
A. Carámbula (2019)
A retrospective observational study of sarcopenia and outcomes in critically ill patients
Patrick R Joyce (2020)
Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population
A. van der Werf (2017)
Predictive factors of in-hospital mortality in ventilated intensive care unit
Chiu-Hua Wang (2017)
Ultrasound assessment of rectus femoris and anterior tibialis muscles in young trauma patients
Maria Giuseppina Annetta (2017)
β-Hydroxy-β-methylbutyrate and its impact on skeletal muscle mass and physical function in clinical practice: a systematic review and meta-analysis.
D. Bear (2019)
Estrogen Maintains Skeletal Muscle in Septic Rats Associated with Altering Hypothalamic Inflammation and Neuropeptides.
C. Zhao (2017)
Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies.
James McKendry (2020)
Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer.
C. Margadant (2016)
Will We Ever Agree on Protein Requirements in the Intensive Care Unit?
S. Mcclave (2017)
Association of Energy and Protein Delivery on Skeletal Muscle Mass Changes in Critically Ill Adults: A Systematic Review
K. Lambell (2018)
High protein intake without concerns?
O. Rooyackers (2017)
DGEM-Leitlinie: „Klinische Ernährung in der Intensivmedizin“
G. Elke (2018)
ICU Admission Muscle and Fat Mass, Survival, and Disability at Discharge: A Prospective Cohort Study
A. Jaitovich (2019)
Skeletal muscle mass and adipose tissue alteration in critically ill patients
M. M. Dusseaux (2019)
Quantification of Adipose Tissue and Muscle Mass Based on Computed Tomography Scans: Comparison of Eight Planimetric and Diametric Techniques Including a Step-By-Step Guide
T. Irlbeck (2018)
See more
Semantic Scholar Logo Some data provided by SemanticScholar