Abstract
BackgroundReduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density.MethodsSingle-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders.ResultsLarger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity.ConclusionIn our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures.
Highlights
Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness
In many ICU survivors, muscle dysfunction persists for years [6, 7], and we have recently reported that reduced pectoralis muscle mass at the time of ICU admission is independently associated with higher mortality during and after ICU care [8]
We extended our prior study [8] by analyzing the association of erector spinae muscle, fat mass, and bone density determined within 24 h of ICU admission with survival and disability at hospital discharge
Summary
Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. Skeletal muscle dysfunction, encompassing wasting and weakness [1, 2], is associated with poor intensive care unit (ICU) outcomes including worse survival [3], need for mechanical ventilation, and higher readmission rate [4,5,6]. In many ICU survivors, muscle dysfunction persists for years [6, 7], and we have recently reported that reduced pectoralis muscle mass at the time of ICU admission is independently associated with higher mortality during and after ICU care [8]. Our previous data indicated that subcutaneous fat mass at the 7th vertebral level measured at ICU admission was not significantly associated with ICU outcomes [8]
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