{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T18:16:50Z","timestamp":1768587410546,"version":"3.49.0"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Better Life Health Corporation","award":["A20192926"],"award-info":[{"award-number":["A20192926"]}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HI18C1216"],"award-info":[{"award-number":["HI18C1216"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Although cross-sectional muscle quality has shown prognostic relevance, the impact of temporal changes in muscle composition in septic shock has not been fully explored. This study aimed to investigate whether deterioration in muscle quality on serial computed tomography (CT) scans is associated with mortality in patients with septic shock. Methods: We conducted a retrospective single-center study using a prospectively collected registry of adult patients with septic shock between May 2016 and May 2022. Patients who underwent CT on the day of emergency department (ED) presentation and had a CT performed more than 180 days earlier were included. Muscle quality maps were generated and segmented based on CT attenuation values into normal-attenuation muscle area (NAMA), low-attenuation muscle area (LAMA), and intramuscular adipose tissue area. Differences between the ED and prior CT scans were also calculated. The primary outcome was the 28-day mortality. Results: Among the 768 enrolled patients, the 28-day mortality was 18.0%. Both survivors and non-survivors showed a significantly greater increase in LAMA (20.8 vs. 9.8 cm2) and a greater decrease in NAMA (\u221226.0 vs. \u221218.8 cm2). Multivariate analysis identified increased LAMA as an independent risk factor for 28-day mortality (adjusted OR 1.03; 95% CI: 1.01\u20131.04; p &lt; 0.01). Conclusions: An increase in LAMA on serial CT scans was associated with higher short-term mortality in patients with septic shock, suggesting that temporal degradation of skeletal muscle quality may serve as a potential prognostic marker.<\/jats:p>","DOI":"10.3390\/diagnostics16020247","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:57:25Z","timestamp":1768229845000},"page":"247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal Degradation of Skeletal Muscle Quality on CT as a Prognostic Marker in Septic Shock"],"prefix":"10.3390","volume":"16","author":[{"given":"June-sung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3496-4134","authenticated-orcid":false,"given":"Jiyeon","family":"Ha","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Korea University Medicine, Goyeong Campus, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youn-Jung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yousun","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyung Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea"},{"name":"Department of Imaging, Dana-Farber Cancer Institute and Brigham and Women\u2019s Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Won Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ageing\/afz046","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kim, Y.J., Seo, D.W., Kang, J., Huh, J.W., Kim, K.W., and Kim, W.Y. (2019). Impact of Body Composition Status on 90-Day Mortality in Cancer Patients with Septic Shock: Sex Differences in the Skeletal Muscle Index. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101583"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1200\/JCO.2015.63.6043","article-title":"Loss of Muscle Mass During Chemotherapy Is Predictive for Poor Survival of Patients With Metastatic Colorectal Cancer","volume":"34","author":"Versteeg","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_6","first-page":"G241","article-title":"Sarcopenia in chronic liver disease: Mechanisms and countermeasures","volume":"320","author":"Allen","year":"2021","journal-title":"Am. J. Physiol. Liver Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/ibd\/izy212","article-title":"Sarcopenia and Inflammatory Bowel Disease: A Systematic Review","volume":"25","author":"Ryan","year":"2019","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_8","first-page":"e23-00003","article-title":"Prognostic Role of Unmeasured Anions Determined by the Stewart Approach in Septic Shock: A Prospective Cohort Study","volume":"6","author":"Uberti","year":"2024","journal-title":"J. Transl. Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s11605-015-2838-8","article-title":"Effect of Intramuscular Adipose Tissue Content on Prognosis in Patients Undergoing Hepatocellular Carcinoma Resection","volume":"19","author":"Kaibori","year":"2015","journal-title":"J. Gastrointest. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1002\/oby.20346","article-title":"Abdominal myosteatosis is independently associated with hyperinsulinemia and insulin resistance among older men without diabetes","volume":"21","author":"Miljkovic","year":"2013","journal-title":"Obesity"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e23049","DOI":"10.2196\/23049","article-title":"Assessment of Myosteatosis on Computed Tomography by Automatic Generation of a Muscle Quality Map Using a Web-Based Toolkit: Feasibility Study","volume":"8","author":"Kim","year":"2020","journal-title":"JMIR Med. Inf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jhep.2015.02.031","article-title":"Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma","volume":"63","author":"Fujiwara","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1097\/DCR.0000000000001352","article-title":"The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer","volume":"62","author":"Hopkins","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1111\/jgh.15068","article-title":"The reproducibility of skeletal muscle signal intensity on routine magnetic resonance imaging in Crohn\u2019s disease","volume":"35","author":"Spooren","year":"2020","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.dld.2019.09.004","article-title":"The additive value of sarcopenia, myosteatosis and hepatic encephalopathy in the predictivity of model for end-stage liver disease","volume":"51","author":"Lattanzi","year":"2019","journal-title":"Dig. Liver Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/CCM.0000000000000742","article-title":"Lactate measurements in sepsis-induced tissue hypoperfusion: Results from the Surviving Sepsis Campaign database","volume":"43","author":"Casserly","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21656","DOI":"10.1038\/s41598-021-00161-5","article-title":"Development of a fully automatic deep learning system for L3 selection and body composition assessment on computed tomography","volume":"11","author":"Ha","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.ejso.2018.05.029","article-title":"Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer","volume":"44","author":"Braak","year":"2018","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3008","DOI":"10.1002\/cncr.31405","article-title":"Muscle radiodensity and mortality in patients with colorectal cancer","volume":"124","author":"Kroenke","year":"2018","journal-title":"Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Stretch, C., Aubin, J.-M., Mickiewicz, B., Leugner, D., Al-Manasra, T., Tobola, E., Salazar, S., Sutherland, F.R., Ball, C.G., and Dixon, E. (2018). Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0196235"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kim, J.-S., Ha, J., Kim, Y.-J., Ko, Y., Park, T., Kim, K.W., and Kim, W.Y. (2022). The Impact of Myosteatosis Percentage on Short-Term Mortality in Patients with Septic Shock. J. Clin. Med., 11.","DOI":"10.3390\/jcm11113031"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Correa-De-Araujo, R., Rossi, A.P., Zamboni, M., Addison, O., Miljkovic, I., and Goodpaster, B. (2022). Editorial: Muscle Quality in Skeletal Muscle Function Deficit: Recent Advances and Potential Clinical and Therapeutic Implications. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.847883"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"309570","DOI":"10.1155\/2014\/309570","article-title":"Intermuscular fat: A review of the consequences and causes","volume":"2014","author":"Addison","year":"2014","journal-title":"Int. J. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/j.1749-6632.2000.tb06416.x","article-title":"Composition of skeletal muscle evaluated with computed tomography","volume":"904","author":"Goodpaster","year":"2000","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2977","DOI":"10.2337\/diacare.26.11.2977","article-title":"Effective exercise modality to reduce insulin resistance in women with type 2 diabetes","volume":"26","author":"Cuff","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"102839","DOI":"10.1016\/j.critrevonc.2019.102839","article-title":"Myosteatosis and prognosis in cancer: Systematic review and meta-analysis","volume":"145","author":"Aleixo","year":"2020","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1093\/ajcn\/71.4.885","article-title":"Thigh adipose tissue distribution is associated with insulin resistance in obesity and in type 2 diabetes mellitus","volume":"71","author":"Goodpaster","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2337\/diacare.26.2.372","article-title":"Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women","volume":"26","author":"Goodpaster","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1152\/jappl.2001.90.6.2157","article-title":"Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study","volume":"90","author":"Goodpaster","year":"2001","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Hamrick, M.W., McGee-Lawrence, M.E., and Frechette, D.M. (2016). Fatty Infiltration of Skeletal Muscle: Mechanisms and Comparisons with Bone Marrow Adiposity. Front. Endocrinol., 7.","DOI":"10.3389\/fendo.2016.00069"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/1754-9485.12124","article-title":"Effect of androgen deprivation therapy on muscle attenuation in men with prostate cancer","volume":"58","author":"Chang","year":"2014","journal-title":"J. Med. Imaging. Radiat. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.metabol.2009.09.014","article-title":"Twenty-eight-day bed rest with hypercortisolemia induces peripheral insulin resistance and increases intramuscular triglycerides","volume":"59","author":"Cree","year":"2010","journal-title":"Metabolism"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yoshihara, I., Kondo, Y., Okamoto, K., and Tanaka, H. (2023). Sepsis-Associated Muscle Wasting: A Comprehensive Review from Bench to Bedside. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24055040"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e24-00008","DOI":"10.1097\/JTCCM-D-24-00008","article-title":"Efficacy of HA380 Hemoperfusion in the Treatment of Septic Shock","volume":"6","author":"Chen","year":"2024","journal-title":"J. Transl. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1359\/jbmr.2001.16.7.1343","article-title":"Race and sex effects on the association between muscle strength, soft tissue, and bone mineral density in healthy elders: The Health, Aging, and Body Composition Study","volume":"16","author":"Taaffe","year":"2001","journal-title":"J. Bone Min. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"11059","DOI":"10.1038\/s41598-018-29427-1","article-title":"Challenges and Opportunities for Emergency Department Sepsis Screening at Triage","volume":"8","author":"Filbin","year":"2018","journal-title":"Sci. Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/247\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T05:43:28Z","timestamp":1768542208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020247"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020247","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]}}}