Screening for low muscularity and sarcopenia risk using thigh ultrasound in critically ill oncology patients: A prospective cohort study

Júlia Zeitum de Lellis; Fernanda Junqueira Stamato Oliveira; Jerusa Márcia Toloi; Izabela Augusta de Oliveira Medeiros; João Manoel Silva-Jr

doi:10.1016/j.clnesp.2025.04.003

Screening for low muscularity and sarcopenia risk using thigh ultrasound in critically ill oncology patients: A prospective cohort study

Clin Nutr ESPEN. 2025 Apr 30:68:160-167. doi: 10.1016/j.clnesp.2025.04.003. Online ahead of print.

Authors

Júlia Zeitum de Lellis¹, Fernanda Junqueira Stamato Oliveira², Jerusa Márcia Toloi³, Izabela Augusta de Oliveira Medeiros⁴, João Manoel Silva-Jr⁵

Affiliations

¹ Barretos Cancer Hospital, R. Antenor Duarte Vilela, 1331, Dr. Paulo Prata, Barretos, SP, 14784-400, Brazil. Electronic address: juliazeitum@gmail.com.
² Barretos Cancer Hospital, R. Antenor Duarte Vilela, 1331, Dr. Paulo Prata, Barretos, SP, 14784-400, Brazil. Electronic address: nutricionista.fernandaj@gmail.com.
³ Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Sala 4107, São Paulo, SP, 01246-903, Brazil. Electronic address: jerusatoloi@gmail.com.
⁴ Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Sala 4107, São Paulo, SP, 01246-903, Brazil. Electronic address: izabela.medeiros@hc.fm.usp.br.
⁵ Barretos Cancer Hospital, R. Antenor Duarte Vilela, 1331, Dr. Paulo Prata, Barretos, SP, 14784-400, Brazil; Surgical Sciences and Perioperative Medicine, Faculty of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Sala 4107, São Paulo, SP, 01246-903, Brazil. Electronic address: joao.s@usp.br.

PMID: 40315985
DOI: 10.1016/j.clnesp.2025.04.003

Abstract

Background & aims: Oncological patients frequently suffer from weight loss, reduced strength, and muscle mass depletion, negatively impacting prognosis and quality of life. This often necessitates intensive care unit (ICU) treatment, where muscle loss is further exacerbated, increasing the risk of sarcopenia. This study aimed to investigate the predictive performance of quadriceps ultrasound as an initial screening tool for reduced muscularity and sarcopenia risk in critically ill oncology patients, using computed tomography (CT) as the comparative standard.

Methods: In this prospective cohort study, patients admitted to an oncological intensive care unit (ICU) between March 2021 and February 2023 were included if they remained in the intensive care unit (ICU) for at least 24 h, had clear third lumbar vertebra (L3) visualization on computed tomography (CT), and provided informed consent. Patients were excluded if they were under palliative care, had amputations of the lower limbs, or had poor-quality computed tomography (CT) imaging that did not allow for accurate assessment. Quadriceps muscle thickness was assessed upon intensive care unit (ICU) admission using the VALIDUM method and compared with computed tomography (CT) findings.

Results: A total of 88 patients were included (mean age 60.6 ± 13.0 years). The most effective method for assessing low muscle mass was ultrasound measurement at two-thirds of the thigh with compression, with a cutoff point of 1.29 cm, yielding a sensitivity of 73.21 % and specificity of 78.12 %. Significant associations were found between measurements below 1.29 cm and lower weight, body mass index (BMI), and skeletal muscle mass index.

Conclusions: Quadriceps ultrasound upon intensive care unit (ICU) admission is a reliable screening method for detecting low muscle mass in critically ill oncological patients, allowing for early intervention to address sarcopenia risk.

Keywords: Computed tomography; Critical illness; Low muscularity; Muscle thickness ultrasound; Nutritional assessment; Ultrasound.