Peripheral Muscle Thickness and Its Association with Outcome in Critically Ill Septic Patients

INTRODUCTION: Skeletal muscle wasting is associated with prolonged hospital stay and mortality. Patients with sepsis are at risk of developing muscle wasting. Ultrasonography (USG) can be used for non-invasive assessment of muscle thickness in ICU setting. Muscle thickness by USG is a good surrogate of muscle mass with good intra and inter-observer reliability. There is paucity of data analysing relationship between ultrasonographic muscle thickness and patient outcome in sepsis. AIM/OBJECTIVES: To assess peripheral muscle by quantitative measures of ultrasonography (cross-sectional area and thickness) and correlate with outcome in patients with sepsis. MATERIAL AND METHODS: A prospective, single centre study was done in patients diagnosed with sepsis or septic shock. Ultrasound was used to measure – Rectus femoris cross sectional area and thickness of quadriceps femoris muscle. Measurement was done at specific intervals – day 1, day 3 and day 5. Patients with pre-existing neuromuscular disease, prolonged immobilization or admission more than 48 hours prior to ICU were excluded. Outcome was measured in terms of Muscle cross-sectional area and thickness would be correlated with patient outcome. In hospital mortality (Primary outcome). Duration of mechanical ventilation. Duration of ICU stay. Duration of hospital stay. RESULTS: A total of 20 patients were included in the study. Initial statistical analysis did not show significant correlation with change in rectus femoris cross sectional area or thickness of quadriceps femoris muscle with patient outcome. Although progressive decline in muscle mass was noted, it did not translate into predicting the outcome of patients. CONCLUSION: Although muscle thickness reduction in USG was correlated with poor outcome in sepsis, this study compared muscle assessment by measuring thickness as well as cross sectional area and found no correlation with outcome. Other causes of muscle mass reduction have to be looked into in critically ill septic patients.