We read with great interest the recent article by Gustafson et al. [1]. The study evaluated the musculoskeletal health status of intensive care unit (ICU) survivors. Their findings suggested that, among 254 patients admitted to the ICU, 59% had musculoskeletal problems yet only 24% received physical therapy after discharge. Given the high incidence and risk of musculoskeletal disorders in patients who are critically ill, the importance of this study deserves to be recognised. However, when it comes to musculoskeletal diseases, sarcopenia is an important topic. This study focused on specific musculoskeletal outcomes rather than the occurrence and development of sarcopenia in this group of patients and its impact on patient prognosis.

At present, the research on sarcopenia has mainly focused on older patients. However, it is worth noting that the incidence of sarcopenia is high in patients who are critically ill. Meyer et al. looked at 1563 critically ill patients with different underlying diagnoses [2]. The pooled overall prevalence of computed tomography (CT)-defined low skeletal muscle mass was 50.9%. Another meta-analysis comprising 3582 patients in ICU receiving mechanical ventilation showed an incidence of sarcopenia ranging from 22% to 71%, with a pooled prevalence of 43% [3]. Sarcopenia was also significantly related to increased mortality and longer durations of mechanical ventilation, ICU and hospital stay [3]. Hanna suggested that if patients who are critically ill subsequently develop sarcopenia, it will be a “deadly intersection” with a poor prognosis [4].

While Gustafson et al. [1] and previous studies [5] have shown that musculoskeletal diseases are associated with multiple adverse outcomes in patients who are critically ill, current clinical guidelines still lack clear direction on standards, systemic treatment and management options for sarcopenia. Although technologies such as dual-energy x-ray absorptiometry (DEXA), CT and magnetic resonance imaging have proven useful in measuring muscle mass, methods for measuring muscle mass in special populations, such as those with critical illness, have not yet been incorporated. Due to the complex condition of these patients, standardised methods and techniques for muscle mass measurement should take these special circumstances into consideration and require wider validation and application. Therefore, significant knowledge gaps exist regarding the diagnosis and treatment of sarcopenia in patients who are critically ill, and further research and guidance are urgently needed to improve clinical practice.

We would like to see further information from this study on the occurrence of sarcopenia in this ICU population and its impact on patient outcomes. We also urge clinicians to pay more attention to musculoskeletal problems in patients with critical illness, especially sarcopenia.

我们饶有兴趣地阅读了 Gustafson 等人最近发表的文章。 [ 1 ]。该研究评估了重症监护病房（ICU）幸存者的肌肉骨骼健康状况。他们的研究结果表明，在 254 名入住 ICU 的患者中，59% 存在肌肉骨骼问题，但只有 24% 的人出院后接受了物理治疗。鉴于重症患者肌肉骨骼疾病的高发病率和风险，这项研究的重要性值得认识。然而，当谈到肌肉骨骼疾病时，肌肉减少症是一个重要的话题。本研究的重点是特定的肌肉骨骼结果，而不是该组患者肌肉减少症的发生和发展及其对患者预后的影响。

目前，关于肌肉减少症的研究主要集中在老年患者。但值得注意的是，重症患者肌少症的发生率较高。迈耶等人。研究人员对 1563 名具有不同潜在诊断的危重患者进行了研究 [ 2 ]。计算机断层扫描 (CT) 定义的低骨骼肌质量的汇总总体患病率为 50.9%。另一项包含 3582 名 ICU 接受机械通气患者的荟萃分析显示，肌少症的发生率为 22% 至 71%，汇总患病率为 43% [ 3 ]。肌肉减少症还与死亡率增加以及机械通气、ICU 和住院时间延长显着相关[ 3 ]。 Hanna建议，如果重症患者随后出现肌少症，这将是预后不良的“致命交叉点”[ 4 ]。

而古斯塔夫森等人。 [ 1 ]和既往研究[ 5 ]表明，肌肉骨骼疾病与危重患者的多种不良结局相关，目前的临床指南在肌少症的标准、系统治疗和管理选择方面仍缺乏明确的指导。尽管双能 X 射线吸收测定法 (DEXA)、CT 和磁共振成像等技术已被证明可用于测量肌肉质量，但尚未纳入特殊人群（例如患有危重疾病的人群）测量肌肉质量的方法。由于这些患者的情况复杂，肌肉质量测量的标准化方法和技术应考虑到这些特殊情况，并需要更广泛的验证和应用。因此，对于重症患者肌少症的诊断和治疗存在重大知识空白，迫切需要进一步的研究和指导来改善临床实践。

我们希望从这项研究中获得有关 ICU 人群肌肉减少症发生率及其对患者预后影响的更多信息。我们也敦促临床医生更多地关注危重症患者的肌肉骨骼问题，尤其是肌少症。