Clin Nutr ESPEN. 2025 May 16. pii: S2405-4577(25)00312-2. [Epub ahead of print]
BACKGROUND: Low muscle mass assessed by the third lumbar vertebra (L3)-targeted abdominal computed tomography-scan (CT-scan) predicts short-term hospital mortality in the intensive care unit (ICU) patients. However, little is known regarding the relation between the L3 muscle and fat areas at ICU admission and 90-day clinical outcomes.
AIMS: to determine the relation between skeletal muscle, subcutaneous, visceral, intramuscular, and total fat cross-sectional areas at ICU admission and 90-day mortality (main), between skeletal muscle and other clinical outcomes, and between body mass index (BMI) and 90-day mortality (secondary).
METHODS: A retrospective observational study was performed in a 10-bed medical ICU. The inclusion criteria were: routine abdominal CT-scan <3 days post-admission, expected length of stay >48 hours. CT-scan assessed skeletal muscle, subcutaneous, visceral and intramuscular fat areas (cm2) at the L3 level. Low skeletal muscle index (SMI) was defined as <38.5 (women) and <52.4 cm2/m2 (men). Actuarial survival curves, univariate analyses and multivariable Cox models were performed.
RESULTS: Out of 200 screened patients, 141 were analyzed: age (mean±standard deviation) 65.2±14.9 years, 59% of males, Simplified Acute Physiology Score (SAPS) II 61.7±21.5, BMI, 27.9±6.4. Kaplan-Meier analysis indicated worse survival in patients with low skeletal SMI (61% (n=39/64) vs. 44 % (n=34/77), P=0.04). Cox multivariable analysis indicated that age ≥65 years (hazard ratio (HR)=1.82 [95% confidence interval, 1.03-3.23], P=0.04), SAPS II (HR=1.03 [1.02-1.04], P<0.001), low SMI (normal vs. low, HR=0.51 [0.31-0.87], P=0.01) and subcutaneous fat index log (HR=0.67 [0.49 - 0.91], P=0.01), were independently associated with 90-day mortality. Visceral, intramuscular and total fat areas were not associated with 90-day mortality. Higher body mass index was associated with lower 90-day mortality (HR=0.92 [0.88-0.96, P<0.001], when the model excluded muscle and fat tissue levels.
CONCLUSIONS: Lower skeletal muscle mass, subcutaneous fat and BMI at ICU admission are associated with higher 90-day mortality. Despite the Global Leadership Initiative on Malnutrition criteria were not used, these results suggest that protein-energy malnutrition at ICU admission is a strong marker of mortality.
Keywords: body composition; critical care outcomes; critical illness; malnutrition; muscle proteins