Use of muscular ultrasound to detect intensive care unit-acquired weakness: a systematic review and Meta-analysis

Abstract Background This systematic review and meta-analysis aims to detecting performance of muscular ultrasound for intensive care unit (ICU)-acquired weakness (ICUAW). Methods We searched PubMed, Web of Science, Embase, Cochrane library, CNKI, VIP, and Wanfang databases for articles published before July 2024. A random-effects model was utilized to derive the summary estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). Additionally, the sources of heterogeneity were explored by subgroup analysis and meta-regression. Results This meta-analysis comprised ten prospective studies involving 561 participants, of whom 241 (42.96%) were diagnosed as ICUAW. Overall, muscular ultrasound exhibited good performance for detecting ICUAW, with the area of SROC curve of 0.85 (95%CI 0.82-0.88), sensitivity of 0.76 (95%CI 0.70-0.81), specificity of 0.80 (95%CI 0.74-0.84), and DOR of 12.43 (95%CI 7.98-19.38). Upon pre-defined subgroup analysis, the rectus femoris exhibited significantly superior discriminatory ability in identifying ICUAW than the non-rectus femoris, with higher SROC (0.88 [95%CI 0.85-0.91] vs. 0.76 [95%CI 0.72-0.79], p < 0.01). Moreover, cross-sectional area was more effective than thickness, with higher specificity (0.86 [95%CI 0.80-0.91] vs. 0.74 [95%CI 0.68-0.79], p = 0.02) and SROC (0.89 [95%CI 0.86-0.92] vs. 0.76 [95%CI 0.72-0.80], p < 0.01). Furthermore, integrated analysis of these two indicators revealed that the cross-sectional area of rectus femoris was statistically superior to the thickness of rectus femoris, with higher sensitivity (0.82 [95%CI 0.74-0.87] vs. 0.75 [95%CI 0.65-0.83], p < 0.05) and AUC (0.91 [95%CI 0.88-0.93] vs. 0.80 [95%CI 0.76-0.83], p < 0.01). Conclusions Muscular ultrasound could be a reliable tool for ICUAW detection. Compared with alternative indices, the cross-sectional area of the rectus femoris exhibits superior detection efficacy and may be considered as a valuable parameter for clinical application.