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. 2023 Jan 6;5(1):e0835.
doi: 10.1097/CCE.0000000000000835. eCollection 2023 Jan.

Relationship Between Skeletal Muscle Quality and Hospital-Acquired Disability in Patients With Sepsis Admitted to the ICU: A Pilot Study

Yuta Takahashi  1   2 , Tomoyuki Morisawa  3 , Hiroshi Okamoto  4 , Noriko Matsumoto  5 , Masakazu Saitoh  3 , Tetsuya Takahashi  3 , Toshiyuki Fujiwara  1   3
Affiliations

Relationship Between Skeletal Muscle Quality and Hospital-Acquired Disability in Patients With Sepsis Admitted to the ICU: A Pilot Study

Yuta Takahashi et al. Crit Care Explor. .

Abstract

Early risk assessment of functional decline in patients with sepsis is clinically challenging. Recently, there is increasing interest in the nonvolitional evaluation of skeletal muscle quality.

Objectives: The aim of this study was to assess the relationship between skeletal muscle quality and functional decline after intensive care.

Design setting and participants: This pilot study was a single-center prospective observational study conducted from March 2021 to February 2022. We included consecutive patients with sepsis who were admitted to our ICU.

Main outcomes and measures: The primary outcome was hospital-acquired disability (HAD), which is defined as a decrease in the Barthel index score of at least 5 points from pre-hospital to hospital discharge. Muscle quality was assessed by: 1) muscle echogenicity with ultrasound and 2) phase angle (PhA) with bioelectrical impedance analysis, both of which were measured on ICU days less than 3, 3-5, 5-7, 7-10, and 10-14. We compared longitudinal changes in muscle echogenicity and PhA between the HAD and non-HAD groups using two-way repeated measures analysis of variance with mixed models.

Results: Among the 22 patients, 7 (31.8%) had HAD. Muscle echogenicity was higher in the HAD group than in the non-HAD group (p < 0.001); however, no interaction effects were found between the two groups (p = 0.189). PhA showed a main effect on each evaluation day in patients (p = 0.040) and a significant interaction effect between the groups, including an early decreased pattern in the HAD group (p = 0.036).

Conclusions and relevance: Higher muscle echogenicity and a decreased PhA pattern are related to HAD. Noninvasive assessment of muscle quality using ultrasound and bioelectrical impedance analysis may be useful in predicting the functional prognosis of patients with sepsis.

Keywords: activities of daily living; bioelectrical impedance analysis; hospital-acquired disability; muscle ultrasound; phase angle; sepsis.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of patient selection process. HAD = hospital-acquired disability.
Figure 2.
Figure 2.
Comparison of the longitudinal change of muscle echogenicity and phase angle in each group. Values are expressed as average (sd). A, Longitudinal change in muscle echogenicity at each time point. B, Longitudinal change in phase angle at each time point. HAD = hospital-acquired disability.
Figure 3.
Figure 3.
Muscle echogenicity analysis images and muscle echogenicity values in patients in the hospital-acquired disability (HAD) and non-HAD groups. RF = rectus femoris, VI = vastus intermedius.
See this image and copyright information in PMC

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