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How does muscularity assessed by bedside methods compare to computed tomography muscle area at intensive care unit admission? A pilot prospective cross-sectional study
Lambell, K J. Earthman, C. P. Tierney, A. C. Goh, G. S. Forsyth, A. King, S. J.
Lambell, K J.
Earthman, C. P.
Tierney, A. C.
Goh, G. S.
Forsyth, A.
King, S. J.
Abstract
Background
Low muscularity and malnutrition at intensive care unit (ICU) admission have been associated with negative clinical outcomes. There are limited data available evaluating the validity of bedside techniques to measure muscle mass in critically ill adults. We aimed to compare bedside methods for muscle mass assessment [bioimpedance spectroscopy (BIS), arm anthropometry and subjective physical assessment] against reference technology [computed tomography (CT)] at ICU admission.
Methods
Adults who had CT scanning at the third lumbar area <72 h after ICU admission were prospectively recruited. Bedside methods were performed within 48 h of the CT scan. Pearson’s correlation compared CT muscle area with BIS-derived fat-free mass (FFM) (kg) and FFM-Chamney (kg) (adjusted for overhydration), mid-upper arm circumference (cm) and mid-arm muscle circumference (cm). Depleted muscle stores were determined using published thresholds for each method. Cohen’s kappa (κ) was used to evaluate the agreement between bedside and CT assessment of muscularity status (normal or low).
Results
Fifty participants were enrolled. There were strong correlations between CT muscle area and FFM values and mid-arm muscle circumference (P < 0.001). Using FFM-Chamney, all six (100%) participants with low CT muscle area were detected (κ = 0.723). FFM-BIS, arm anthropometry and subjective physical assessment methods detected 28%–38% of participants with low CT muscle area.
Conclusions
BIS-derived FFM using an adjustment algorithm for overhydration was correlated with CT muscle area and had good agreement with muscularity status assessed by CT image analysis. Arm anthropometry and subjective physical assessment techniques were not able to reliably detect participants with low CT muscle area.
Keywords
critical illness, nutrition assessment, bioelectrical impedance, computed tomography, skeletal muscle mass, body composition
Date
2021
Type
Journal article
Journal
Journal of Human Nutrition and Dietetics
Book
Volume
34
Issue
2
Page Range
345-355
Article Number
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled