Elsevier

Clinical Nutrition

Volume 32, Issue 5, October 2013, Pages 772-776
Clinical Nutrition

Original article
Sarcopenia: Prevalence and prognostic significance in hospitalized patients

https://doi.org/10.1016/j.clnu.2013.01.010Get rights and content

Summary

Background

Sarcopenia is prevalent in older populations with many causes and varying outcomes however information for use in clinical practice is still lacking.

Aims

The aim of this report is to identify the clinical determinants and prognostic significance of sarcopenia in a cohort of hospitalized acutely ill older patients.

Methods

Four hundred and thirty two randomly selected patients had their baseline clinical characteristic data assessed within 72 h of admission, at 6 weeks and at 6 months. Nutritional status was assessed from anthropometric and biochemical data. Sarcopenia was diagnosed from low muscle mass and low muscle strength-hand grip using anthropometric measures based on the European Working Group criteria.

Results

Compared with patients without sarcopenia, those diagnosed with sarcopenia 44 (10%) were more likely to be older, have more depression symptoms and lower serum albumin concentration. The length of hospital stay (LOS) was significantly longer in patients diagnosed with sarcopenia compared with patients without sarcopenia [mean (SD) LOS 13.4 (8.8) versus 9.4 (7) days respectively, p = 0.003]. The risk of non-elective readmission in the 6 months follow up period was significantly lower in patients without sarcopenia compared with those diagnosed with sarcopenia (adjusted hazard ratio .53 (95% CI: .32 to .87, p = 0.013). The death rate was also lower in patients without sarcopenia 38/388 (10%), compared with those with sarcopenia 12/44 (27%), p-value = .001.

Conclusion

Older people with sarcopenia have poor clinical outcome following acute illness compared with those without sarcopenia.

Introduction

An important challenge of modern medicine is to distinguish physiological changes associated with the process of ageing from disease and adverse life style factors whose cumulative effects account for many of the adverse events in older people. Although a number of these changes and events lead to progressive decline in health many are responsive to treatment. This has created a need for additional knowledge of age-related changes, which has importance in the treatment and prevention of disease, and in maintaining good health and quality of life in an ageing population. An important example of this challenge is sarcopenia, a condition which is prevalent in older populations with many causes and varying outcomes.1 It is a syndrome characterized by progressive decline in skeletal mass, decreased strength and functional status and associated with physical disability, poor quality of life and death.2, 3 There are a number of mechanisms involved in the aetiology and pathogenesis of sarcopenia and their contribution vary over time. Recognizing underlying causes is expected to help guide treatment and therefore minimize adverse outcomes.4, 5, 6 Currently the presence of low muscle mass and low muscle function (strength or performance) are used for the diagnosis of sarcopenia.2, 5, 6 Although sarcopenia has emerged as an acceptable syndrome which predict outcomes not many data on hospitalized patients are available. Furthermore a valid and reproducible measurement technique of sarcopenia suitable for clinical practice is still a challenge. The aim of this report is to measure the prevalence and prognostic significance of sarcopenia in a cohort of acutely ill older patients.

Section snippets

Subjects

Four hundred and thirty two unselected acutely ill older patients who took part in a randomized controlled trial with complete data were included.7 Inclusion criteria were: age ≥ 65 years; stable medical condition and able to sign an informed written consent form. Patients excluded from the study were those with severe medical or psychiatric illness including those with malignancy, severe dementia and living in institution. The study received local research ethics committee approval.

All

Results

All 432 acutely ill older patients who took part in a previously published randomized controlled trial with complete data were included in this analysis.7 Forty- four out of 432 patients (10%) were diagnosed with sarcopenia. Table 1 shows baseline clinical characteristics according to the presence of the diagnosis of sarcopenia including gender, smoking, alcohol consumption, disability, depression and quality of life scores, tissue inflammation (CRP), haemoglobin, albumin and transferrin.

Discussion

This study shows that older patients with the diagnosis of sarcopenia had poor clinical outcome over 6-month period following acute illness compared with those without sarcopenia after adjusting for a number of important poor prognostic indicators.

Sarcopenia leads to impaired ability to perform activities of daily living, disabilities, loss of independence, increased risk of falls, fractures and death. Despite recent scientific interest in the subject, information on sarcopenia among acutely

Author's contribution

SG is the principal investigator and wrote the first draft of the manuscript. AE contributed to analysis of the data and the discussion. Both authors read and approved the final manuscript.

Conflict of interest

None.

Acknowledgement

The index study was funded by THE HEALTH FOUNDATION project grant. Thank you to Sarah Forster for her help with data collection.

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