Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

Abstract

Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

Correlation of Sarcopenia With Modified Frailty Index as a Predictor of Outcome in Critically Ill Elderly Patients: A Cross-Sectional Study

“…There was a statistically significant correlation between the length of ICU stay and the sarcopenic and non-sarcopenic groups in the study by Mohanty et al [16], whereas, in our study, no such correlation was associated. In a study by Zhang et al [17], age was found to be an important confounding factor, whereas, in our study, we did not have age as a confounding factor. Also, in addition, there were a number of important confounding factors, such as chronic obstructive pulmonary disease (COPD), obesity, and cardiac failure, which would have influenced sarcopenia's impact on mortality, whereas, in our study, no such confounding factors were observed.…”

“…As far as gender is considered, sarcopenia is higher in women. Few studies had shown an estimated prevalence of 15.3% in men and 20.5% in women in a tertiary-care hospital [ 16 , 17 ].…”

Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

“…In our study, the malnourished group had longer duration of MV than the normal nutritional status group (P < 0.05). As demonstrated by Jaitovich et al [13] and Weijs et al [14], low muscle mass is an independent risk factor for mortality in critically ill patients [15]. Thus, early identi cation of low muscle mass may lead to more timely nutritional support, which may bene t the prognosis of patients.…”

Skeletal muscle depletion predicts death in severe community-acquired pneumonia patients entering ICU

“…According to the literature, the complication rate of sarcopenia in ICU was 41%, and the hospital mortality of patients with sarcopenia was higher (OR= 2.28, P<0.001). 9 Finally, we planned to recruit no less than 148 patients (with a unilateral significance level of 0.05 and a beta risk of 0.20). In the beginning, we collected 274 patients (age>18 years old) diagnosed with SCAP and admitted to ICU between January 2019 and July 2021.…”

“…As age increases, the continuous decline of muscle mass and loss of function could lead to falls, weakness, and even death. 8,9 As digital imaging develops, CT imaging of psoas area, paravertebral, appendix, and paraspinal muscle has become a reliable methodology for diagnosing sarcopenia. [10][11][12][13] The area of the psoas muscle was the most commonly used indicator for skeletal muscle mass.…”