• Sunmi Ju, Sun Mi Choi, Young Sik Park, Chang-Hoon Lee, Sang-Min Lee, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, and Jinwoo Lee.
• Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
• J Intensive Care Med. 2020 Jul 1; 35 (7): 663-671.

PurposeTo assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis.Materials And MethodsPatients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality.ResultsAmong 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss.ConclusionRapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

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