Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: a secondary analysis of a cohort study
Simone Bernardes, Bruna Barbosa Stello, Danielle Silla Jobim Milanez, Elisa Loch Razzera, Flávia Moraes Silva- Nutrition and Dietetics
- Medicine (miscellaneous)
ABSTRACT
Background and Aim
Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides superior prognostic value for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients than its unadjusted measurement.
Methods
In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 hours of ICU admission. We adjusted calf circumference for body mass index (BMI) (25–29.9, 30–39.9, and ≥ 40 kg/m2) by subtracting it in 3, 7, or 12 cm, respectively. Values ≤ 34 cm for males and ≤ 33 cm for females identified low calf circumference.
Results
We analyzed 325 patients. In the primary risk‐adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI‐adjusted) groups (HR 0.90, 95% CI 0.47–1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40–6.05). Every 1 cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes.
Conclusions
Calf circumference BMI‐adjusted did not exhibit independent associations with ICU and in‐hospital death, nor did ICU and in‐hospital LOS compared to its unadjusted measurement. However, low calf circumference (unadjusted and BMI‐adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.
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