ABSTRACT
Objective
The present study aimed to investigate the association of quadriceps muscle thickness, measured by ultrasound, with the nutritional status of critically ill patients in a referral high-complexity trauma care hospital.
Methods
A cross-sectional observational study was conducted in the intensive care units in a tertiary hospital in Brazil. The sample comprised 30 critically ill trauma patients admitted between February and March 2022. The methodology involved evaluating muscle mass and comparing nutritional status through mid-upper arm circumference measurements and ultrasound assessments. Specifically, the quadriceps muscle thickness was quantified using ultrasound at a predefined site between the iliac crest and the proximal border of the patella.
Results:
The Kruskal-Wallis test indicated variability in quadriceps muscle thickness between the nutritional status groups, with statistical significance reached after excluding the overweight group (H(2) = 7.532, p=0.023). The moderate malnutrition group exhibited notably lower quadriceps muscle thickness. A positive correlation was found between quadriceps muscle thickness and mid-upper arm circumference adequacy (p<0.05), demonstrating fair to moderately strong correlation (rs=0.531).
Conclusion
Significant changes in quadriceps muscle thickness were detected by ultrasound assessment in moderate malnutrition patients compared to patients of other nutritional statuses. Ultrasound may be a valuable technique for monitoring muscle integrity in critically ill patients.
Keywords
Imaging; Intensive Care Units; Malnutrition; Muscle, skeletal; Nutritional status; Quadriceps muscle; Ultrasonics
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Note: ICU: Intensive Care Unit; QMT: Quadriceps Muscle Thickness; US: Ultrasound.
Note: Figure A: Point corresponding to two-thirds of the distance between the iliac crest and the patella. Figure B: Quadriceps muscle thickness as detected by a participant’s ultrasound image. The dotted line represents the full thickness of the quadriceps (rectus femoris and vastus intermedius complex). RF: rectus femoris; VI: vastus intermedius; VL: Vastus Lateralis; VM: Vastus Medialis. In the image, only small portions of the VM and VL are visible. These images are licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Note: Box and whisker plots illustrate the quadriceps muscle thickness (QMT) (cm) across four nutritional status groups classified based on mid-upper arm circumference adequacy (%). Mild malnutrition displays the highest median QMT, followed by Eutrophy, Overweight and Moderate malnutrition. An outlier, represented by a dot, is evident below Mild malnutrition box. The interquartile range (IQR) provides the distribution dispersion about the median. The Overweight group demonstrates an absence of IQR, indicating a limited data set comprising two observed values.
Note: Scatter plots (Figures A and C) and histograms overlayed with a density curve (Figures B and D) illustrating the distribution of p-values derived from Kruskal-Wallis test based on bootstrap resampling on quadriceps muscle thickness across four distinct nutritional statuses: Moderate malnutrition, Mild malnutrition, Eutrophy, and Overweight. The assessment utilized 2,000 iterations, consistent with the Monte Carlo simulation parameters. Figure A: Further dispersion of points across the entire p-value range indicates variability in the results. A significant proportion (59.95%) of these tests yielded results with p-values less than 0.05. A dashed red line, marking p=0.05, serves as a reference point for statistical significance. Figure B: Two dashed lines of significance are evident on the graph: a red line marking the adopted significance threshold of p=0.05 and an orange line indicating the mean p-value of 0.0898 for our data. Figure C: A significant proportion (65.3%) of these tests yielded results with p-values less than 0.05. A dashed red line, marking p=0.05, serves as a reference point for statistical significance. Figure D: Two dashed lines of significance are evident on the graph: a red line marking the adopted significance threshold of p=0.05 and a green line indicating the mean p-value of 0.0649 for our data.
Note: Figure A: Scatter plot illustrating the relationship between quadriceps muscle thickness (cm) and the mid-upper arm circumference (cm). Figure B: Scatter plot illustrating the association between quadriceps muscle thickness (cm) and the mid-upper arm circumference adequacy (%). Each data point represents an individual measurement. The significance level was set at p<0.05.