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Meta-Analysis
. 2025 Jun 3;29(1):223.
doi: 10.1186/s13054-025-05427-2.

Exploring the association between computed tomography (CT)-derived skeletal muscle mass and short- and long-term mortality in critically ill patients: a systematic review and meta-analysis

Valeria A Bertoni Maluf  1 , François R Herrmann  2 , Alexandra Platon  3   4 , Aline Mendes  2 , Yves M Dupertuis  1 , Aude De Watteville  5 , Claudia P Heidegger  5   6 , Laurence Genton  7   8
Affiliations
Meta-Analysis

Exploring the association between computed tomography (CT)-derived skeletal muscle mass and short- and long-term mortality in critically ill patients: a systematic review and meta-analysis

Valeria A Bertoni Maluf et al. Crit Care. .

Abstract

Background: Low skeletal mass, often present at hospital admission, has been associated with poor prognoses.

Aim: To explore the association between computed tomography (CT)-derived skeletal muscle mass at the lumbar level and short- and long-term mortality in critically ill patients.

Methods: Following PRISMA 2020 guidelines, we included studies on critically ill adults (≥ 18 years) hospitalized in intensive care units (ICU) that measured CT-derived skeletal muscle mass at the lumbar vertebral level within ± 7 days of ICU admission. The primary outcome was mortality, categorized as short-term (including ICU, hospital, 28- and 30-day mortality) and long-term (> 30 days) mortality. MEDLINE and Embase databases were searched without date restrictions. Study screening was performed using Rayyan, data extraction was guided by a custom-designed tool, and quality assessment was performed using the JBI Cohort Study Checklist. A meta-analysis was conducted, focusing on studies that reported short- and long-term mortality among patients with preserved and reduced skeletal muscle. A prevalence meta-analysis was also performed for studies that reported the size of subgroups with low muscle mass.

Results: Out of 1248 unique records, 35 studies met the inclusion criteria, involving 9366 participants. The majority were retrospective, single-centre studies conducted on four continents and included heterogeneous populations such as patients with sepsis, COVID-19 and trauma. Sample sizes ranged from 36 to 939, with a wide age range, from 40 to 70 s, and a predominance of male patients (62%). Skeletal mass was most commonly reported as skeletal muscle index at the third lumbar vertebra. Studies reported mainly short-term mortality on day 28 or 30. Long-term mortality, measured at 90 days, 6 months, and 1 year, was evaluated in 11 studies. Meta-analyses revealed that low skeletal muscle mass area and index were significantly associated with increased risks of both short (OR = 2.33, CI 1.90-2.87, I2 = 41.39%)-and long-term mortality (OR = 2.67, CI 1.45-4.92, I2 = 62.24%). The overall prevalence of low muscle mass was 42% (CI 34-49%, I2 = 98.2%).

Conclusions: CT-assessed skeletal muscle mass at the lumbar level on admission to ICU is associated with both short- and long-term mortality. It may serve as a prognostic marker in critically ill patients. Standardized protocols for measuring and defining low skeletal muscle mass in this population are essential to improve comparability across studies.

Keywords: Computed tomography; Critical illness; Intensive care; Mortality; Muscle mass; Skeletal muscle mass.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interest: The authors declare that they have no competing interests. Declaration of generative AI and AI-assisted technologies in the writing process: During the preparation of this work the authors used DeepL Write and ChatGPT to improve language and readability. After using these tools, the authors reviewed and edited the content as needed and takes full responsibility for the content of the publication. This systematic review was conducted in parallel with a retrospective observational study, for which a protocol was submitted to the Ethics Committee of the Canton of Geneva and registered on ClinicalTrials.gov (NCT05834894). While the overarching study protocol was registered, a separate protocol specific to this systematic review was not published.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram study selection and inclusion process
Fig. 2
Fig. 2
Meta-analysis of low muscle mass (MM) and short-term (ICU, hospital, 28- and 30-day) mortality in critically ill patients. Figure A shows the OR mortality calculated according to the number of deaths (n), when reported in the primary studies. Figure B adds 4 additional studies where the sample size of the number of deaths was not reported
Fig. 3
Fig. 3
Meta-analysis of low muscle mass (MM) and long-term (90-days, 6-months, 1-year) mortality in critically ill patients. Figure A shows the OR mortality calculated according to the number of deaths (n), when available, or provided in the primary studies. Figure B adds 1 additional study where the sample size of the number of deaths was not reported
Fig. 4
Fig. 4
Meta-analysis of the prevalence of low muscle mass among 22 Studies reporting subgroup sample sizes
See this image and copyright information in PMC

Comment in

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