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Quadriceps Femoris Ultrasonography: A Tool to Assess Nutritional Status and Prognosticate Mortality Outcome in Adult Mechanically Ventilated Patients

Author: Zulaikha Zahir

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Zulaikha Zahir¹, Ariffin Marzuki¹, Saedah Ali¹, Ahmad Tarmizi², Kamarul Azmanie Kamaruzaman³


Objective. Intensive Care Unit patients possess higher nutritional risk due to their heterogeneity of demographic factors and disease trajectories upon hospitalization. mNUTRIC score was then used to classify them  into High Nutritional Risk; HNR (Score ≥5) or Low Nutritional Risk; LNR. These HNR patients have been shown to have significant muscle loss during ICU stay which had significant adverse outcomes. Thus, skeletal muscle ultrasonography was introduced as a tool to assess the nutritional status thus predicting their outcome.

Methods. A prospective cohort study involving 60 patients was conducted in Hospital Universiti Sains Malaysia, whereby their blood parameters, skeletal muscle thickness, and nutritional intake measurement were recorded during their ICU stay. The adverse outcome such as duration of mechanically ventilated days, hospitalisation days and mortality were recorded. The serial percentage decline of quadriceps femoris thickness is then used to prognosticate mortality.

Results. Overall, the recruited patients had mean APACHE II score 13, SOFA score 8, Charlson Comorbidity Index score 3.3, and average score for mNUTRIC score is 3.6. This study revealed that 85% of our patients received optimal nutritional delivery by an average of 2.6 days. The  HNR patients had a significant percentage of skeletal muscle thickness decline by Day 5, with ≥7.80% decline can predict mortality.  However, there were no statistically significant changes in mechanical ventilated days and hospitalization days. 

Conclusion. Ultrasonography of quadriceps femoris is perceived as a new emerging utility as a surrogative tool to assess nutritional status and predicting mortality. Serial scanning of quadriceps femoris is seen as a more dynamic approach to evaluate the degree of muscle wasting, thus alarming for an earlier method for nutritional optimization, early muscle rehabilitation and patient mobility which may reduce the morbidity and mortality of these patients. 

Keywords: mNUTRIC score, critical ill nutrition, ultrasonography, Quadriceps femoris, mortality


  1. Department of Anaesthesiology and Intensive Care Unit, Hospital Universiti Sains Malaysia.
  2. Department of Radiology, Hospital Universiti Sains Malaysia.
  3. Department of Dietetic and Nutrition, Hospital Universiti Sains Malaysia


Correspondence to: Zulaikha Zahir, Dr. , Hospital Universiti Sains Malaysia, Malaysia, [email protected]


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