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. Objective: 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 mode. 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 38% (95% CI:36%-39%). Critically ill patients with sarcopenia in intensive care unit have an increased risk of mortality, compared to critically ill patients without sarcopenia (HR=2.22, 95%CI: 1.79-2.75; P<0.001; I2=0.0%). In addition, a subgroup analysis found a significant difference in the association between sarcopenia and mortality when using total psoas muscle area (TPA), skeletal muscle index (SMI), and skeletal muscle area (SMA) to define sarcopenia (HR=2.96,95%CI:1.72-5.11,P<0.001; HR = 2.11,95%CI:1.59-2.80,P<0.01; HR=2.11, 95%CI:1.33-3.33,P=0.001, respectively), whereas the results were not significant when measuring the masseter muscle to define sarcopenia (HR=2.00, 95%CI:0.82-4.90,P=0.129).Conclusion: Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments, offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?

“…The need for invasive mechanical ventilation may increase due to atrophy of the respiratory muscles [27]. The length of MV, ICU and hospital stay may be prolonged due to sarcopenia [3,25,26]. In our cohort, the length of MV, ICU and hospital stay were longer in the low PNI group than the high PNI group.…”

“…In these patients, the prevalence of malnutrition at admission is around 33% [9,14,15]. Malnutrition can cause loss of muscle strength and sarcopenia in critically ill patients [26,27]. The need for invasive mechanical ventilation may increase due to atrophy of the respiratory muscles [27].…”

The current use of ultrasound to measure skeletal muscle and its ability to predict clinical outcomes: a systematic review

“…There is now a wealth of data to show that patients with reduced muscle mass and function (sarcopenia), and those who suffer acute muscle wasting during treatment, are at higher risk of treatment-related complications, take longer to recover, and have worse overall survival. [3][4][5][6][7] This phenomenon transcends disease types but is especially pronounced in patients who are nutritionally vulnerable such as older patients and those with cancer. 8 Low muscle mass combined with obesity is a particularly dangerous combination where significant loss of muscle may go undetected by simply monitoring body weight or anthropometrics alone.…”

“…Skeletal muscle is the major component of lean body mass and plays an important homeostatic, metabolic, and physical functioning role. There is now a wealth of data to show that patients with reduced muscle mass and function (sarcopenia), and those who suffer acute muscle wasting during treatment, are at higher risk of treatment‐related complications, take longer to recover, and have worse overall survival 3–7 . This phenomenon transcends disease types but is especially pronounced in patients who are nutritionally vulnerable such as older patients and those with cancer 8 .…”

Influence of Early Multidisciplinary Collaboration on Prevention of ICU-Acquired Weakness in Critically Ill Patients

“…Critically ill patients (CIPs) are often accompanied by multiple organ dysfunction, which not only increases the risk of death but also imposes a certain social burden on medical care [1]. Intensive care unit-(ICU-) acquired weakness (AW), a common acute neuromuscular injury in CIPs, is associated with poor short-and long-term outcomes [2].…”