Advanced Skeletal Muscle Mass Reduction (Sarcopenia) Secondary to Neuromuscular Disease

Area of Science:

• Neurology
• Geriatrics
• Clinical Nutrition

Background:

• Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease impacting mobility and requiring ventilatory and nutritional support.
• Patients with ALS often experience decreased mobility, leading to muscle atrophy and potential sarcopenia.
• Assessing muscle mass in critically ill patients is crucial for understanding prognosis.

Observation:

• A young male patient with ALS, dependent on a ventilator and percutaneous endoscopic gastrostomy (PEG) feeding, was evaluated.
• Skeletal muscle (SM) mass was estimated using 24-hour urinary creatinine excretion.
• The SM index was calculated by indexing SM mass to height and weight.

Findings:

• The patient exhibited the lowest recorded SM index at 2.2 kg/m², signifying extremely advanced sarcopenia.
• This value is significantly below the threshold for severe sarcopenia in males (≤ 8.5 kg/m²).
• Urinary creatinine excretion provides a viable method for assessing sarcopenia in intensive care unit (ICU) settings.

Implications:

• This non-invasive method can help identify sarcopenia in ICU patients, including those with ALS.
• Sarcopenia is a recognized predictor of mortality in critically ill populations.
• Early identification of sarcopenia may allow for targeted interventions to improve patient outcomes.