Prognostic Value of Muscle Mass Measured via Brain Computed Tomography in Neurocritically Ill Patients

We investigated whether skeletal muscle mass estimated via brain computed tomography (CT) can be used to predict neurological outcomes in neurocritically ill patients. Adult patients who were admitted to the neurosurgical intensive care unit (ICU) from January 2010 to September 2019 were eligible. We included patients who were hospitalized in the neurosurgical ICU for more than 7 days. Cross-sectional areas of paravertebral muscle at the first cervical vertebra level (C1-CSA) and temporalis muscle thickness (TMT) on brain CT were measured to evaluate skeletal muscle mass. Primary outcome was Glasgow Outcome Scale score at 3 months. Change of C1-CSA (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.054–1.761) and change of TMT (adjusted OR: 1.27, 95% CI: 1.028–1.576) were significantly associated with poor neurological outcome (Hosmer–Lemeshow test, Chi-square = 11.4, df  = 8, p  = 0.178) with areas under the curve of 0.803 (95% CI 0.740–0.866) using 10-fold cross validation method. Especially, risk of poor neurologic outcome was proportional to changes of C1-CSA and TMT. In this study, the follow-up skeletal muscle mass at first week from ICU admission, based on changes in C1-CSA and TMT, was associated with neurological prognosis in neurocritically ill patients.