Sarcopenia and Mortality Risk of Patients with Sepsis: A Meta-Analysis

Abstract

Background. The association between sarcopenia at admission and mortality in patients with sepsis has not been comprehensively evaluated. We performed a meta-analysis to systematically evaluate the above association. Methods. This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intrastudy heterogeneity was selected to pool the results. Subgroup analyses were applied to evaluate the influences of study characteristics on relationship. Results. Ten cohort studies including 2396 patients with sepsis were included, and 1496 (62.4%) of them had sarcopenia at presentation. Pooled results showed that compared to those without sarcopenia, septic patients with sarcopenia had a significantly increased early (in-hospital or 1-month) mortality risk (risk ration (RR): 2.14, 95% confidence interval (CI): 1.60–2.87, P < 0.001; I2 = 46%). Subgroup analyses showed consistent association between sarcopenia and increased acute mortality risk in septic patients which were not affected by study characteristics such as study design, country of the study, clinical settings, diagnostic criteria for sepsis, age, gender of the patients, and methods for diagnosis of sarcopenia ( P for all subgroup analyses >0.05). Further meta-analyses showed that sarcopenia was also associated with increased mortality risk in septic patients at 3–6 months (RR: 2.13, 95% CI: 1.58–2.89, P < 0.001; I2 = 0%) and at 1 year (RR: 1.57, 95% CI: 1.09–2.24, P = 0.01; I2 = 29%). Conclusions. Current evidence suggests that sarcopenia may be a predictor of mortality in patients with sepsis.

Computed tomography-based body composition is associated with adverse clinical outcomes among older patients with sepsis in the emergency department

“…In this study, the mortality rate of older patients with sepsis was 36.6%, which approximated that reported in a previous study (38.7%) [10]. In consensus with recent meta-analyses [7,8], we found that lower muscle mass, as a continuous variable, was an independent risk factor for 90-day mortality. However, another study showed that muscle wasting-associated comorbidities, rather than sarcopenia, were risk factors for hospital mortality in critically ill patients with abdominal sepsis [16].…”

“…Patients discharged or transferred within 24 hours (n = 40) or without abdominal CT (n = 127) were excluded. CT scans of 16 patients did not meet quality checks, including artifacts (7), muscle or adipose tissue outside the scanned frame (5), and poor differentiation between the muscle and surrounding tissue (4). Therefore, 443 patients were finally included and followed up, with a 90-day mortality rate of 36.6% (162 patients died) (Fig.…”

“…Abdominal computed tomography (CT) is used as a diagnostic examination in the emergency department (ED), and its secondary analysis can be applied to evaluate body composition and define sarcopenia without added economic and radiation burdens to the patient [6]. Previous studies have proved that loss of muscle mass or sarcopenia had an intimate association with mortality of patients with sepsis [7][8][9].…”

Long-Term Clinical Outcomes in Critically Ill Patients with Sepsis and Pre-existing Sarcopenia: A Retrospective Cohort Study

“…In contrast, current literature surrounding chronic, post-sepsis illness suggests that much of the disease morbidity occurs in the weeks to months following acute illness [18]. A meta-analysis of 2396 patients investigated sarcopenia as a risk factor for poor post-sepsis outcomes, similarly reported early (in-hospital or 1-month) mortality as the primary measured outcome [19]. This meta-analysis incorporated studies utilizing three different definitions of sepsis, the earliest of which dates back to 1992 [20].…”

Sciatic Denervation-Induced Skeletal Muscle Atrophy Is Associated With Persistent Inflammation and Increased Mortality During Sepsis

“…Patients with low skeletal muscle mass are more susceptible to infection and have a higher mortality rate, owing to sepsis, compared with those who have high skeletal muscle mass (7). In recent years, meta-analyses have indicated the impact of skeletal muscle atrophy on sepsis prognosis (8). Cox et al (7) reported that a poor prognosis in sepsis is associated with pre-existing skeletal muscle atrophy rather than acute muscle atrophy due to sepsis alone.…”