S27 

Quadriceps Femoris Ultrasonography: A Tool to Assess Nutritional Status and Prognosticate 

Mortality Outcome in Adult Mechanically Ventilated Patients 

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

 
Objective: Intensive Care Unit (ICU) patients possess higher nutritional risk due to their heterogeneity 

of demographic factors and disease trajectories upon hospitalization. mNUTRIC score was 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 led to significant 

adverse outcomes. Thus, skeletal muscle ultrasonography was introduced as a tool to assess the 

nutritional status thus predicting their disease outcome. 

Methods: A prospective cohort study involving 60 patients was conducted in Hospital Universiti Sains 

Malaysia, whereby blood parameters, skeletal muscle thickness, and nutritional intake measurement of 

the patients were recorded during their ICU stay. The adverse outcome such as duration of mechanically 

ventilated days, hospitalisation days and mortality events were recorded. The serial percentage decline 

of quadriceps femoris thickness is then used to prognosticate mortality. 

Results: Overall, the recruited patients had a mean APACHE II score of 13, SOFA score of 8, Charlson 

Comorbidity Index score of 3.3, and the 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 

that can predict mortality.  However, there were no statistically significant changes in mechanical 

ventilated days and hospitalisation days.  

Conclusion: Ultrasonography of quadriceps femoris was perceived as a new emerging utility as a 

surrogate tool to assess nutritional status and predict mortality. Serial scanning of quadriceps femoris 

was seen as a more dynamic approach to evaluate the degree of muscle wasting, thus alarming for an 

earlier method for nutritional optimisation, early muscle rehabilitation and patient mobility which may 

reduce morbidity and mortality of these patients.  

 

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

 

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1Department of Anaesthesiology and Intensive Care Unit, Hospital Universiti Sains Malaysia. 

2Department of Radiology, Hospital Universiti Sains Malaysia. 

3Department of Dietetic and Nutrition, Hospital Universiti Sains Malaysia 

Correspondence to:  

Zulaikha Zahir, Dr. , Hospital Universiti Sains Malaysia, Malaysia, zulaikha88zahir@gmail.com  

  

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DOI: http://dx.doi.org/10.31344/ijhhs.v6i0.417

mailto:zulaikha88zahir@gmail.com