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\begin{document}

\title{SARCOPENIA DETECTED IN AGED PATIENTS IN INTENSIVE CARE UNITS IS
ASSOCIATED WITH POOR PROGNOSIS}



\author[1]{Belgin Akan}%
\author[1]{Derya Gokcinar}%
\author[1]{Lale DAMGACI}%
\author[1]{Esra Cakir}%
\author[2]{Hamza Özer}%
\author[1]{Isil Ozkocak  Turan}%
\affil[1]{Ankara City Hospital}%
\affil[2]{Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi}%


\vspace{-1em}



  
  \date{May 14, 2024}


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\selectlanguage{english}
\begin{abstract}
Objective: The aim of this study was to evaluate the diagnosis of
sarcopenia by abdominal tomography, prevelance and prognosis in critical
patient admitted to intensive care unit(ICU). Methods: It was planned as
a retrospective observational study. Patients older than 40 years of age
with abdominal tomography who needed to be in the ICU were included.
Muscle mass was measured by abdominal tomography. All patients were
divided into two groups as sarcopenic and non-sarcopenic according to
the measurement results. We compared the prognosis and clinical features
of patients with and without sarcopenia. Results: Fifty five(59\%) of
all patients were found as sarcopenic and 70.8\% over 70 years of age.
The length of stay in ICU and in hospital were 27.8 \selectlanguage{ngerman}± 29.7 and 33.0 ±
31.2 days in sarcopenic patients, 15.1±17 and 23.8±21.3 days in
nonsarcopenic patients respectively(p \textless{}0.05). Thirty day
mortality was found 49.1\% in patients sarcopenic(\textless{}0.05). SMI
was found lower over aged 70 years(p \textless{}0.05). Conclusions:
Sarcopenia was associated with the increasing of 30 day mortality, a
prolongation in the lenght of stay in ICU and hospital. Therefore, we
believe that awareness about sarcopenia will be important in order to
shorten the mortality and lenght of stay in ICU.%
\end{abstract}\selectlanguage{ngerman}%



\sloppy


\textbf{SARCOPENIA DETECTED IN AGED PATIENTS IN INTENSIVE CARE UNITS IS
ASSOCIATED WITH POOR PROGNOSIS}

\textbf{SHORT TITLE: Sarcopenia detected in intensive care unit}

\textbf{ABSTRACT}

\textbf{Objectiv} e: The aim of this study was to evaluate the diagnosis
of sarcopenia by abdominal tomography, prevelance and prognosis in
critical patient admitted to intensive care unit(ICU).

\textbf{Methods:} It was planned as a retrospective observational study.
Patients older than 40 years of age with abdominal tomography who needed
to be in the ICU were included. Muscle mass was measured by abdominal
tomography. All patients were divided into two groups as sarcopenic and
non-sarcopenic according to the measurement results. We compared the
prognosis and clinical features of patients with and without sarcopenia.

\textbf{Results:} Fifty five(59\%) of all patients were found as
sarcopenic and 70.8\% over 70 years of age. The length of stay in ICU
and in hospital were 27.8 \selectlanguage{ngerman}± 29.7 and 33.0 ± 31.2 days in sarcopenic
patients, 15.1±17 and 23.8±21.3 days in nonsarcopenic patients
respectively(p \textless{}0.05). Thirty day mortality was found 49.1\%
in patients sarcopenic(\textless{}0.05). SMI was found lower over aged
70 years(p \textless{}0.05).

\textbf{Conclusions:} Sarcopenia was associated with the increasing of
30 day mortality, a prolongation in the lenght of stay in ICU and
hospital. Therefore, we believe that awareness about sarcopenia will be
important in order to shorten the mortality and lenght of stay in ICU.

\textbf{Key Words:} Sarcopenia, skeletal mass index, abdominal
computerized tomography, intensive care unit, prevelance, mortality

\textbf{What's known?}

\begin{itemize}
\tightlist
\item
  Sarcopenia is an increasingly common geriatric problem.
\item
  It may develop due to age-related or systemic diseases.
\item
  Nutrition and exercise are protective against sarcopenia.
\end{itemize}

\textbf{What's new?}

\begin{itemize}
\tightlist
\item
  We found that sarcopenia was common in patients hospitalized in the
  intensive care unit.
\item
  We have seen that sarcopenia prolongs the length of stay in the
  intensive care unit and hospital and increases mortality.
\item
  Early detection of sarcopenia is benefical in aged people in ICU and
  appropriate approach may reduce the harmful consequences of sarcopenia
  and length of stay in ICU
\end{itemize}

\textbf{INTRODUCTION}

Sarcopenia was first described by Irwin Rosenberg in 1989, who defined
sarcopenia as a condition of age-related loss of muscle mass {[}1{]}. In
2009 The European Sarcopenia Study Group (EWGSOP) defined sarcopenia as
``a syndrome characterised by progressive and generalised loss of
skeletal muscle mass and strength with a risk of adverse outcomes such
as physical disability, poor quality of life and death'' {[}2{]}. In the
fourth decade of life, muscle mass and appendicular skeletal muscle
strength begin to decrease. A reduction of 3\% or more in the functional
capacity of the muscle from the age of sixth decade and a loss of more
than 50\% muscle mass from the eighth decade {[}3{]}. The prevalence of
sarcopenia has been reported by EWGSOP as 5-13\% and 11-50\% for 60-70
years and over 80 years of age respectively {[}4{]}. In a study using
computed tomography (CT) in intensive care unit (ICU), the frequency of
sarcopenia was found to be 15-50 \% in cancer patients, 30-45 \% in
patients with liver failure and 60-70 \% in critically ill patients
{[}4,5{]}. It is expected that it will affect 1.2 million people in 2025
and 2 million people in 2050 {[}6{]}.

The distinctions of `primary sarcopenia' and `secondary sarcopenia' have
been proposed by EWGSOP. Primary sarcopenia indicates muscle wasting
related to aging, while secondary sarcopenia, refers to muscle loss
related to inflammation or malnutrition. Because it is mostly due to
multiple reasons, classification as primary or secondary may not always
be reasonable {[}3{]}. Considering that the muscle mass is approximately
60\% of the body weight, the pathological changes due to the excessive
losses may have very large clinical consequences, especially in an aged
population {[}2{]}. Clinical examination is used for the diagnosis of
sarcopenia, where hand-grip strength is less than 20 kg in women and
less than 30 kg in men and gait speed is below 0.8 m/sec. Sarcopenia in
trunk muscles is a dominant risk factor that adversely affects
prognosis. However, it is not possible for every patient to be diagnosed
with clinical examination in ICU patients. Since radiological
examinations show the relationship between total body fat and muscle
mass, they can be used in the diagnosis of sarcopenia. Abdominal
computerized tomography (CT) is accepted as the gold standard methods
for diagnosing sarcopenia by fully evaluating fat tissue and muscle mass
{[}2{]}. In the abdominal CT, L3 vertebra region is correlated with the
muscle mass in the whole body. Therefore, the cross-sectional total area
(with adipose tissue and skeletal muscle) is evaluated in abdominal CT
including psoas, paraspinal muscles (erector spinae, quadratus lumborum)
and abdominal wall muscles (transversus abdominis, external and internal
obliques, rectus abdominus) at the level of L3 vertebra. In order to
normalize the skeletal muscle index (SMI) according to the height, the
total muscle area is divided by the square of the height and is defined
in unit of cm\textsuperscript{2}/m\textsuperscript{2} {[}6,7{]}.
Similarly, the evaluation of the thickness of the psoas muscle in the
lumbar 3\textsuperscript{rd} or 4\textsuperscript{th} vertebra may help
in determining mortality after major surgery {[}8,9{]}. The measurement
of the anterior-posterior diameter of the transverse psoas muscle at the
umbilical level and the normalization by dividing the height is another
radiological parameter used in the diagnosis {[}10{]}.

Sarcopenia may not be considered in patients when first admission to
ICU. They are all known to be negatively associated with ICU survival.
It is important to predict mortality and stratify the risk of death in
ICUs. There are few studies evaluating the frequency of sarcopenia and
its relation with mortality in the ICU. Although there are articles
about the relationship between sarcopenia and mortality {[}11,12{]}.
There are also articles reporting that there is no relationship
{[}13{]}. In this study, it was aimed to evaluate the diagnosis of
sarcopenia by abdominal CT, the prevalence of sarcopenia and its
relationship with prognosis in patients who are admitted to tertiary
general ICU for a certain period, also to raise awareness of the
intensivist about sarcopenia.

\textbf{MATERIALS AND METHODS}

\textbf{Study Design}

The study was planned as a retrospective and observational study and
performed after the approval from the ethics committee of Health
Sciences University Ankara Numune Training and Research Hospital
(approval number is E. Kurul-E-18-1928). Among all patients hospitalized
in a tertiary general ICU between 1 May 2017 and 30 April 2018, patients
over the age of 40 who underwent abdominal CT during their follow-up in
the ICU were included in the study.

\textbf{Data Collection and Definitions}

Medical records of these patients were reviewed. Patients with missing
data and without abdominal CT were not included in the study. This study
screening, inclusion and exclusion flow chart is presented in Figure 1.

Radiological evaluation of the patients with abdominal CT was performed
by the same experienced radiologist using standard anatomical landmarks.
During abdominal CT the muscles at the level of L3 vertebra were
determined and the psoas, paraspinal muscles (erector spinae, quadratus
lumborum) and abdominal wall muscles (transverse abdominus, external and
internal obliques, rectus abdominus) were marked. The muscle
cross-sectional area at the level of L3 was used as it was linearly
associated with whole-body muscle mass, and by dividing this value by
the square of the height the skeletal muscle index was calculated for
each patient in cm\textsuperscript{2}/ m\textsuperscript{2}. CT scan
with 64-detector (Aquilion 64, Toshiba Medical Systems, Tochigi, Japan,
2011) was used in abdominal CT. Two mm section thickness, 64 x 0.5
collimation, 0.5 seconds rotation time, 120 kV and 300 mA were used in
CT investigations. The evaluation of the images was done on the OsiriX
(10.0, 64 bit, Switzerland) workstation. The evaluation was performed at
L3 vertebral level, in the axial section in which both transverse
projections were observed. Skeletal muscle area was measured by 2D/3D
segmentation tool at this level. In skeletal muscle area measurements,
pixels in the range of -30, +150 Hounsfield Unit (HU) density were
marked by automatic segmentation {[}14,15{]}. The necessary adjustments
in the marked contours of the fields have been made manually.

\textbf{Measurements of outcome}

The cut off value for L3 skeletal muscle index was accepted as 38.5
cm\textsuperscript{2}/m\textsuperscript{2} in women and 52.4
cm\textsuperscript{2}/m\textsuperscript{2} in men {[}16{]}. According to
these threshold values, patients were divided into two groups as
sarcopenic and non-sarcopenic patients. The demographic data of
patients, primary diagnosis at admission to ICU (respiratory failure,
sepsis, cardiovascular failure, neurological, gastrointestinal symptoms,
multi-trauma, surgical, cancer, drug overdose), comorbidities, body mass
index (BMI), APACHE II (Acute Physiology and Chronic Health Evaluation)
and SOFA (Sequential Organ Failure Assesment) scores, blood prealbumin,
albumin, Vitamin D, urea and creatinine level, nutrition status (total
parenteral or enteral nutrition), duration of ventilation, length of
stay in ICU and hospital, and prognosis in the ICU (alive or death) were
recorded.

\textbf{Statistically Analysis}

IBM SPSS Statistics for Windows v.21.0 (IBM Corp., Armonk, NY) was used.
Descriptive statistics were expressed as mean, median, standard
deviation, minimum-maximum for numerical variables and as number and
percentage \selectlanguage{english}\selectlanguage{english}for categorical variables. The assumption of normality was
examined with the Kolmogorov-Smirnov test, which failed to meet the
assumption. Kruskal-Wallis test was used to determine whether there was
a difference between groups. In the case of differences between the
groups, paired comparison tests were used to determine the group that
drove the difference. The differences between categorical variables were
examined by chi-square test. The significance level was accepted as
p\textless{}0.05.

\textbf{RESULTS}

Among the 445 patients admitted to the tertiary general ICU, 105
patients were found to meet the study inclusion criteria. Twelve
patients with incomplete data were excluded from the study. Data of the
remaining 93 patients were analyzed (Figure 1).

There was no statistically difference between men and women in terms of
the frequency of sarcopenia (p\textgreater{}0.05). BMI was higher in
nonsarcopenic patients than sarcopenic patients (25.6+-3.5 vs 24.2+-4.8,
p\textless{}0.05). Fifty five (59\%) of all patients were found as
sarcopenic (p\textless{}0.05). The characteristics of the patients,
reasons for admission to the ICU and comorbidities were similar between
goups (p\textgreater{}0.05) (Table 1). The presence of sarcopenia, and
APACHE II and SOFA scores were similar between groups (p\textgreater{}
0.05). Prealbumin levels were significantly lower in the sarcopenic
group (p \textless{}0.001). Vit D, albumin, urea, creatinine, nutrition
status and mechanical ventilation time were not different between the
groups (p\textgreater{} 0.05). The length of stay in ICU and in hospital
were 27.8+-29.7 and 33.0+-31.2 days in sarcopenic patients, 15.1+-17 and
23.8+-21.3 days in nonsarcopenic patients respectively (p
\textless{}0.05). Mortality was found to be 49.1\% in patients with
sarcopenia, and this value was found to higher in non-sarcopenic
patients (Table 2). SMI was lower in patients over the age of 70
compared to those older than 40 (p \textless{}0.05) (Table 3).

\textbf{DISCUSSION}

In this study the prevalance of sarcopenia was found to be 59\% in the
patients admitted to general ICU in a one-year period and most common in
patients over 70 years of age. Sarcopenia was associated with the
increasing in mortality, the prolongation in the lenght of staying at
hospital and ICU.

EWGSOP reported the incidence of sarcopenia as 5.8-14.9\% in the normal
population, 4.1\% in men and 16.6\% in women (2). On the other hand,
they reported that the incidence in the elderly was between 1-29\% (17).
Moisey et al found this figure to be 71\% in aged trauma patients (18).
However, the number of studies investigating the incidence of sarcopenia
in critically ill patients is low. Sheean et al found the incidence of
sarcopenia as 62\% in patients who were admitted to ICU due to
respiratory failure and followed up in mechanical ventilator (19). Joyce
et al reported the incidence of sarcopenia in their patients
hospitalized in their intensive care unit as 68\% (13). Baggerman et al
were reported that the prevalence of sarcopenia is approximately 30-70
\% in intensive care units (5). In the present study, we found the
incidence of sarcopenia in general ICU as 59\%, similar to literature.

Malnutrition is closely related to sarcopenia in aged persons and plays
an important role in the development of sarcopenia. Mundi et al showed
that 50\% of the critically ill patients were malnourished, which is the
reason for impaired immune function, long-term ventilator dependence,
increased infectious complications, and increased morbidity and
mortality (20). It is important to evaluate the nutritional status of
first admission in patients admitted to ICU, but it is difficult to
assess the history of acute weight loss. Protein deficiency disrupts the
immune system by increasing metabolic stres (21). Baumgartner et al
found an association between albumin levels and sarcopenia (22). Kim et
al reported that higher albumin levels were associated with a protective
effect against declines in SMI (23). Although there was no difference in
albumin levels in our patients, we found prealbumin levels lower in
patients with sarcopenia. Prealbumin is a protein produced by the liver.
Serum prealbumin had historically been used as a biomarker of
malnutrition and as an important indicator of overall nutrition status
among aged adults not suffering from acute illness. Chen et al reported
that lower prealbumin levels were associated with higher sarcopenia
prevelance. Therefore higher BMI and prealbumin levels may be protective
factors against sarcopenia development among aged adults (24). We
consider that muscle mass or strength might decline due to degradation
of protein synthesis associated with low prealbumin, which may lead to
an increased risk of sarcopenia in critical illness.

BMI is a parameter used in the evaluation of nutrition, based on height
and weight. But body weight includes both fat and muscle mass.
Therefore, it prevents us from making the accurate assessment for
sarcopenia. Weijs et al reported that the measurement of muscle mass was
a more important indicator than BMI (25). In some studies, acute
sarcopenia due to muscle destruction and decreased protein synthesis has
been shown in critically ill patients. Muscle volume decrement was shown
as 17-30\% in the first 10 days of the ICU (26). The use of BMI may also
cause inaccurate results in the presence of diffuse edema, especially in
obese patients. Albumin or other serum proteins are affected by the
acute phase response and changes in the intravascular volume so prevent
the use of as a marker for the assessment of nutritional status in the
critical patient (27). In CT imaging, body compartments can be better
distinguished, and abdominal fat tissue, visceral adipose tissue,
intramuscular, and subcutaneous adipose tissue can be identified more
accurately. Therefore, abdominal CT is defined as standard method for
evaluating total body and skeletal muscle (21). Sheetz et al evaluated
SMI in abdominal CT preoperatively and reported sarcopenia (28). Martin
et al reported that SMI was closely related to mortality and associated
with poor prognosis, especially in the aged patients (29). In the
present study, abdominal CT was used for SMI evaluation. Patients were
divided into two groups for SMI values based on Prado's threshold values
(16). SMI was found to be lower in patients over the age of 70 compared
to those older than 40.

The general ICU population is very heterogeneous. The mortality of
critically ill patients is still one of the most important issues,
especially for the elderly patients with comorbidities. Most patients
have sepsis, and suffering from chronic comorbidities such as
cardiovascular failure, trauma, malnutrition or cancer. These
comorbidities are associated with a decline of skeletal muscle mass,
potentially leading to sarcopenia. Various scoring systems are used to
predict mortality. However, these scoring systems have shown relatively
poor predictable performance. We used APACHE II and SOFA scores in ICU.
However, we couldn't find any differences between the groups.

In several studies, it has been stated that low levels of vitamin D
cause a decrease in muscle tension. Vitamin D deficiency should be
treated to maintain vitamin D levels of 40 ng/mL and above (29,30). Any
relationship between serum vitamin D levels and muscle mass was not
found in this study.

In the presence of sarcopenia; length of mechanical ventilation, length
of stay in ICU and hospital are longer and consequently an cost
increases (28). Moisey et al found the number of days on ventilator and
the number of days of intensive care to be higher. Hospital stay was
longer and mortality was higher in the sarcopenic patients (18). Weijs
et al they reported that low muscle mass evaluated with CT was related
to increased duration of mechanical ventilation and increased duration
of hospitalization and mortality (25). Kirk et al reported that the
presence of preoperative sarcopenia increases the incidence of admission
to the intensive care unit and prolongs the duration of discharge (21).
The patients were admitted to ICU with a severe critical disease
accompanied by comorbidities, protein catabolism, muscle atrophy and
weakness. Sarcopenia caused an increase in mortality, a prolongation in
the lenght of hospitalization and ICU stay. In the present study,
mortality was increased and lengths of intensive care and hospital stay
were prolonged in the presence of sarcopenia,

Limitations of the study; it was a retrospective and single centered
study. Data were obtained directly from the medical records of the
patients. Patients with abdominal CT for any reason were included.
Primary or secondary sarcopenia could not be differentiated because
abdominal CT at any time was evaluated during the treatment in the ICU.
There were cases that could not be evaluated because of missing data.
Response to treatment could not be evaluated (adequate nutrition,
specifically protein and micronutrients such as Vit D).

\textbf{CONCLUSION}

We demonstrated that sarcopenia is highly prevalent in the aged
population in ICU. Traditonal measures of nutritional assessment such as
BMI and measuring prealbumin levels is important but not always
meaningful. Early detection of sarcopenia is benefical in aged people in
ICU and appropriate approach may reduce the harmful consequences of
sarcopenia and length of stay in ICU.

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\textbf{28.} Sheetz KH, Waits SA, Terjimanian MN, et al. Cost of major
surgery in the sarcopenic patient. J Am Coll Surg 2013;217(5):813-8.

\textbf{29.} Martin L, Birdsell L, Mac Donald N, et al. Cancer cachexia
in the age of obesity: skeletal muscle depletion is a powerful
prognostic factor, independent of body mass index. J Clin Oncol 2013;
31:1539-47.

\textbf{30.} Bruyere O, Cavalier E, Reginster JV. Vitamin D and
osteosarcopenia: an update from epidemiological studies. Curr Opin Clin
Nutr Metab Care 2017;20(6):498-503.

\textbf{31.} Kou HW, Yeh CH, Tsai HI, Hsu CC, Hsieh YC, Chen WT, et al.
Sarcopenia is an effective predictor of difficult-to-wean and mortality
among critically ill surgical patients. PlosOne 2019;14(8): e0220699.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Table I. Demographic characteristics of the groups}\selectlanguage{english}
\begin{longtable}[]{@{}llllll@{}}
\toprule
Parametres & Parametres & N (\%) & Sarcopenic Group & Non-sarcopenic
Group & p value\tabularnewline
\midrule
\endhead
Age (Years) & 41-50 & 25(26.9\%) & 9 (33.3\%) & 16 (66.7\%) &
0.001\tabularnewline
& 51-60 & 10 (20\%) & 8(80\%) & 2(20\%) &\tabularnewline
& 61-70 & 17(18.3\%) & 10(18.2\%) & 7(18.4\%) &\tabularnewline
& 70\textless{} & 41(34.8\%) & 28(70.8\%) & 13(29.2\%) &\tabularnewline
Sex & Female & 37(40\%) & 21 (38.2\%) & 16(42.1\%) & 0.86\tabularnewline
& Male & 56(60\%) & 34 (61.8\%) & 22(57.9\%) &\tabularnewline
BMI (kg/m\textsuperscript{2}) & BMI (kg/m\textsuperscript{2}) & BMI
(kg/m\textsuperscript{2}) & 25.6 \selectlanguage{ngerman}±3.5 & 24.2 \selectlanguage{ngerman}±4.8 & 0.04\tabularnewline
Prevelance & Prevelance & Prevelance & 55 (59.0\%) & 38 (41.0\%) &
0.03\tabularnewline
Primary diagnosis & Primary diagnosis & Primary diagnosis & Primary
diagnosis & Primary diagnosis & Primary diagnosis\tabularnewline
Neurological disease & Neurological disease & Neurological disease &
13(61.9\%) & 8(38.09\%) & 0.96\tabularnewline
Respiratory & Respiratory & Respiratory & 7 (63.6\%) & 4(36.3\%) &
0.90\tabularnewline
Cardiovascular & Cardiovascular & Cardiovascular & 2 (66.6\%) & 1
(33.4\%) & 0.21\tabularnewline
Gastrointestinal & Gastrointestinal & Gastrointestinal & 7 (63.6\%) & 4
(36.3\%) & 0.90\tabularnewline
Cancer & Cancer & Cancer & 6 (66.6\%) & 3 (33.3\%) & 0.15\tabularnewline
Sepsis & Sepsis & Sepsis & 4 (66.6\%) & 2 (33.3\%) & 0,16\tabularnewline
Multi-trauma & Multi-trauma & Multi-trauma & 11 (52.4\%) & 10 (47.6\%) &
0.61\tabularnewline
Postoperative & Postoperative & Postoperative & 3 (75.0\%) & 1 (25.0\%)
& 0.49\tabularnewline
Drug overdose, suicide & Drug overdose, suicide & Drug overdose, suicide
& 3 (50.0\%) & 3(50.0\%) & 0.51\tabularnewline
Comorbidities & Comorbidities & Comorbidities & Comorbidities &
Comorbidities & Comorbidities\tabularnewline
DM & DM & DM & 6 (42.9\%) & 8 (57.1\%) & 0.36\tabularnewline
HT & HT & HT & 15 (55.5\%) & 12 (41.4\%) & 0.91\tabularnewline
KAD & KAD & KAD & 14 (58.3\%) & 10 (41.6) & 0.90\tabularnewline
Stroke & Stroke & Stroke & 6 (42.9\%) & 8 (57.1\%) & 0.10\tabularnewline
COPD & COPD & COPD & 5 (62.5\%) & 3 (37.5\%) & 0.73\tabularnewline
Malignity & Malignity & Malignity & 14 (58.3\%) & 10 (41.6\%) &
0.18\tabularnewline
Demans & Demans & Demans & 3 (50.0\%) & 3 (50.0\%) & 0.41\tabularnewline
Chronic renal insufficiences & Chronic renal insufficiences & Chronic
renal insufficiences & 5 (62.5\%) & 3 (37.5\%) & 0.61\tabularnewline
Hepatic failure & Hepatic failure & Hepatic failure & 3 (50.0\%) & 3
(50.0\%) & 0.88\tabularnewline
\bottomrule
\end{longtable}

Note: Results are demonstrated as mean \selectlanguage{ngerman}± SD or n (\%)

BMI: Body mass index

\textbf{Table II. Comparison of patients admission characteristics of
Sarcopenic and Non-sarcopenic groups}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\textbf{Parametres}\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\textbf{Sarcopenic}\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\textbf{Non-sarcopenic}\strut
\end{minipage} & \begin{minipage}[b]{0.17\columnwidth}\raggedright\strut
\textbf{p value}\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
APACHE II\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
21.2\selectlanguage{ngerman}±9.2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
18.1\selectlanguage{ngerman}±9.7\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
SOFA\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6.5\selectlanguage{ngerman}±3.2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
6.0\selectlanguage{ngerman}±3.7\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Prealbumin\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.08\selectlanguage{ngerman}±0.05\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.1\selectlanguage{ngerman}±0.05\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.006\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Albumin\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
2.7\selectlanguage{ngerman}±0.8\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
3.0\selectlanguage{ngerman}±0.08\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.1\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Vitamin D\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9.7\selectlanguage{ngerman}±10.6\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.3\selectlanguage{ngerman}±4.5\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
BUN\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
8.01\selectlanguage{ngerman}±1.04\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
7.6\selectlanguage{ngerman}±0.9\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.2\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Creatinin\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.7\selectlanguage{ngerman}±1.5\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
1.5\selectlanguage{ngerman}±1.3\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.7\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
GFR\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
63.4\selectlanguage{ngerman}±36.2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
67.9\selectlanguage{ngerman}±35.7\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.6\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Nutrition\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
TPN EN\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
18 (\%32.7) 37(67.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
9(\%23) 29(\%76.3)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.5\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Mechanical ventilation\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
Yes No\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
39(\%70.9) 16(\%29.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
22(\%57.9) 16(\%42.1)\strut
\end{minipage} & \begin{minipage}[t]{0.19\columnwidth}\raggedright\strut
0.3\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Length of stay ICU\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
27.8\selectlanguage{ngerman}±29.7\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
15.1\selectlanguage{ngerman}±17\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.001\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Length of stay in hospital\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
33.0\selectlanguage{ngerman}±31.2\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
23.8\selectlanguage{ngerman}±21.3\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.04\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Outcome\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Death\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
27(\%49.1)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
9(\%23)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
0.02\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
Alive\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
28(\%50.9)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
29(\%76)\strut
\end{minipage} & \begin{minipage}[t]{0.17\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Note: Results are demonstrated as mean \selectlanguage{ngerman}± SD or n (\%)

APACHE II: Acute physiology and Chronic Health Evaluation

SOFA: Sequential Organ Failure Assessment Score

\textbf{Table III. Comparison of skeletal mass index between sarcopenic
and nonsarcopenic groups}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Age(Years)} & \textbf{Age(Years)} & \textbf{Mean Difference} &
\textbf{Standard Error} & \textbf{p value}\tabularnewline
\midrule
\endhead
\textbf{41-50} & \textbf{51-60} & 22.02 & 9.66 & .377\tabularnewline
& \textbf{61-70} & 20.65 & 8.61 & .279\tabularnewline
& \textbf{71 \textless{}} & 27.29\textsuperscript{*} & 8.13 &
.018\tabularnewline
\textbf{51-60} & & & &\tabularnewline
& \textbf{41-50} & -22.02 & 9.66 & 0.37\tabularnewline
& \textbf{61-70} & -1.364906 & 8.613395 & 1.000\tabularnewline
& \textbf{71 \textless{}} & 5.277508 & 8.134873 & 1.000\tabularnewline
\textbf{61-70} & & & &\tabularnewline
& \textbf{41-50} & -20.655494 & 8.613395 & .279\tabularnewline
& \textbf{51-60} & 1.364906 & 8.613395 & 1.000\tabularnewline
& \textbf{71\textless{}} & 6.642414 & 6.851392 & 1.000\tabularnewline
\textbf{71\textless{}} & & & &\tabularnewline
& \textbf{41-50} & -27.297908\textsuperscript{*} & 8.134873 &
.018\tabularnewline
& \textbf{51-60} & -5.277508 & 8.134873 & 1.000\tabularnewline
& \textbf{61-70} & -6.642414 & 6.851392 & 1.000\tabularnewline
\bottomrule
\end{longtable}

\textbf{Hosted file}

\verb`Table 1.docx`  available at \url{https://authorea.com/users/397903/articles/538361-sarcopenia-detected-in-aged-patients-in-intensive-care-units-is-associated-with-poor-prognosis}

\textbf{Hosted file}

\verb`Table 2.docx`  available at \url{https://authorea.com/users/397903/articles/538361-sarcopenia-detected-in-aged-patients-in-intensive-care-units-is-associated-with-poor-prognosis}

\textbf{Hosted file}

\verb`Table 3.docx`  available at \url{https://authorea.com/users/397903/articles/538361-sarcopenia-detected-in-aged-patients-in-intensive-care-units-is-associated-with-poor-prognosis}

\textbf{Hosted file}

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\selectlanguage{english}
\FloatBarrier
\end{document}

