Journal of palliative medicine · 2026
Ultrasound-Derived Muscle Biomarkers as a Gateway toward Quantitative Pediatric Frailty in Palliative Care.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Peñafiel José Fernández-Cuesta, Mingorence Alvaro Navarro, Mrtín Veronica Puertas, Martino Alba Ricardo
Аннотация
BACKGROUND: Adult frailty scales rely on performance tests that are rarely feasible in children. Quantitative muscle ultrasound (US) could provide an objective bridge, but its pediatric utility is untested.
OBJECTIVE: To explore whether US-derived biomarkers Z-scores can cluster into recognizable patterns that serve as preliminary building blocks toward a quantitative definition of pediatric frailty.
DESIGN AND SETTING: Eight-month, single-center exploratory cross-sectional observational study in a pediatric palliative care unit.
PARTICIPANTS: Twenty-four consecutively enrolled children (1-18 years) with advanced but clinically stable, life-limiting conditions (83.5% neurometabolic, 16.5% oncologic), recruited with parental informed consent.
PROCEDURES: Rectus femoris and vastus intermedius were scanned with standardized presets (64 dB gain; 4 cm depth). Age- or weight-adjusted Z-scores for muscle thickness, echo-intensity (EI), and subcutaneous-fat were derived from a published pediatric dataset. Each child was plotted in 3-D "health cubes" (x = muscle-thickness z, y = EI z, z = subcutaneous-fat z).
RESULTS: All patients lay outside the ± 2 SD "normality cube" for at least one reference set.Median (IQR) muscle-thickness z = -4.9 (-5.6 to -4.1); EI z = +3.7 (+2.1 to +5.8).Thickness and EI were inversely correlated (ρ = -0.62, p = 0.002); lower thickness modestly predicted shorter time-to-death (ρ = -0.55, p = 0.01).
CONCLUSIONS: In this modest, single-center cohort, pediatric palliative patients consistently deviated from normative muscle US ranges, forming a distinct cluster outside the "Работает" 3-D zone. While not diagnostic, these patterns support further, larger, longitudinal studies to develop composite US indices and formal cut-points for pediatric frailty. This visual framework may accelerate that process by highlighting multidimensional outliers at the bedside.
OBJECTIVE: To explore whether US-derived biomarkers Z-scores can cluster into recognizable patterns that serve as preliminary building blocks toward a quantitative definition of pediatric frailty.
DESIGN AND SETTING: Eight-month, single-center exploratory cross-sectional observational study in a pediatric palliative care unit.
PARTICIPANTS: Twenty-four consecutively enrolled children (1-18 years) with advanced but clinically stable, life-limiting conditions (83.5% neurometabolic, 16.5% oncologic), recruited with parental informed consent.
PROCEDURES: Rectus femoris and vastus intermedius were scanned with standardized presets (64 dB gain; 4 cm depth). Age- or weight-adjusted Z-scores for muscle thickness, echo-intensity (EI), and subcutaneous-fat were derived from a published pediatric dataset. Each child was plotted in 3-D "health cubes" (x = muscle-thickness z, y = EI z, z = subcutaneous-fat z).
RESULTS: All patients lay outside the ± 2 SD "normality cube" for at least one reference set.Median (IQR) muscle-thickness z = -4.9 (-5.6 to -4.1); EI z = +3.7 (+2.1 to +5.8).Thickness and EI were inversely correlated (ρ = -0.62, p = 0.002); lower thickness modestly predicted shorter time-to-death (ρ = -0.55, p = 0.01).
CONCLUSIONS: In this modest, single-center cohort, pediatric palliative patients consistently deviated from normative muscle US ranges, forming a distinct cluster outside the "Работает" 3-D zone. While not diagnostic, these patterns support further, larger, longitudinal studies to develop composite US indices and formal cut-points for pediatric frailty. This visual framework may accelerate that process by highlighting multidimensional outliers at the bedside.