Clinical utility of measuring temporal muscle volume by head computed tomography for Global Leadership Initiative on Malnutrition phenotypic criteria in critically ill patients

Abstract

Background

The Global Leadership Initiative on Malnutrition (GLIM) lacks endorsed criteria for a muscle mass assessment. Since a muscle mass assessment using trunk computed tomography (CT) cannot be performed on all patients, a temporal muscle evaluation may serve as an useful alternative. In the present study, we hypothesized that complementing a total skeletal muscle mass assessment with a temporal muscle evaluation may provide a viable strategy for the GLIM assessment in the intensive care unit (ICU).

Methods

This single-center retrospective cohort study analyzed adult ICU patients. We selected optimal cut-off values for temporal muscle mass, measured by head CT, to predict sarcopenia as defined by the total skeletal muscle mass index in patients who underwent both abdominal and head CT. A reduced muscle mass, a component of the phenotypic criteria, was then evaluated using abdominal and head CT images. Muscle mass was assessed using abdominal CT if the patient underwent abdominal CT imaging and head CT if the patient only underwent head CT imaging. Patients who met at least one GLIM phenotypic criterion and one etiologic criterion were diagnosed with malnutrition. Clinical outcomes, including in-hospital mortality, were compared between patients with and without malnutrition.

Results

A total of 270 patients were included. The optimal cut-off for temporal muscle area was 250.11, adopted as the threshold for a reduced muscle mass. The combination of head and abdominal CT enabled muscle mass assessments in 215 (80 %) patients, whereas abdominal CT alone allowed assessments in 149 (55 %) patients. Malnutrition was identified in 71 patients (33 %) with assessments using abdominal and head CT. In-hospital mortality was significantly higher in the malnutrition group (29.6 % vs. 9.7 %, p < 0.01).

Conclusion

A muscle mass evaluation using both head and abdominal CT images enables the GLIM assessment in a larger patient population. This approach may support the GLIM assessment in ICU patients.