title: Can Sarcopenia Quantified by Ultrasound of the Rectus Femoris Muscle Predict Adverse Outcome of Surgical Intensive Care Unit Patients as well as Frailty? A Prospective, Observational Cohort Study.
abstract: OBJECTIVE
  To compare sarcopenia and frailty for outcome prediction in surgical intensive care unit (SICU) patients.
  
  
  BACKGROUND
  Frailty has been associated with adverse outcomes and describes a status of muscle weakness and decreased physiological reserve leading to increased vulnerability to stressors. However, frailty assessment depends on patient cooperation. Sarcopenia can be quantified by ultrasound and the predictive value of sarcopenia at SICU admission for adverse outcome has not been defined.
  
  
  METHODS
  We conducted a prospective, observational study of SICU patients. Sarcopenia was diagnosed by ultrasound measurement of rectus femoris cross-sectional area. Frailty was diagnosed by the Frailty Index Questionnaire based on 50 variables. Relationship between variables and outcomes was assessed by multivariable regression analysis NCT02270502.
  
  
  RESULTS
  Sarcopenia and frailty were quantified in 102 patients and observed in 43.1% and 38.2%, respectively. Sarcopenia predicted adverse discharge disposition (discharge to nursing facility or in-hospital mortality, odds ratio 7.49; 95% confidence interval 1.47-38.24; P = 0.015) independent of important clinical covariates, as did frailty (odds ratio 8.01; 95% confidence interval 1.82-35.27; P = 0.006); predictive ability did not differ between sarcopenia and frailty prediction model, reflected by χ values of 21.74 versus 23.44, respectively, and a net reclassification improvement (NRI) of -0.02 (P = 0.87). Sarcopenia and frailty predicted hospital length of stay and the frailty model had a moderately better predictive accuracy for this outcome.
  
  
  CONCLUSIONS
  Bedside diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty. Sarcopenia assessed by ultrasound may be utilized as rapid beside modality for risk stratification of critically ill patients.
authors.affiliation: *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA†Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, University of California, San Diego, CA‡Departments of Surgery and Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA§Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA¶Department of Surgery, University of Michigan Medical School, Ann Arbor, MI||Inserm Research Center for Epidemiology and Biostatistics (U897)-Team Neuroepidemiology, University of Bordeaux, College of Health Sciences, Bordeaux, France**University of Bordeaux, College of Health Sciences, Bordeaux, France††Department of Anesthesia and Critical Care Medicine, University Duisburg-Essen, Essen, Germany.
authors.forename: Noomi
authors.initials: N
authors.lastname: Mueller
authors.forename: Sushila
authors.initials: S
authors.lastname: Murthy
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Tainter
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.forename: Kathleen
authors.initials: K
authors.lastname: Riddell
authors.forename: Florian J
authors.initials: FJ
authors.lastname: Fintelmann
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Grabitz
authors.forename: Fanny P
authors.initials: FP
authors.lastname: Timm
authors.forename: Benjamin
authors.initials: B
authors.lastname: Levi
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D055948:Sarcopenia / Q000150:complications* / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires