Sarcopenia Measured Using Masseter Area Predicts Early Mortality following Severe Traumatic Brain Injury

Abstract

Sarcopenia is strongly associated with poor outcomes and mortality following injury among the geriatric population. Diagnosis using psoas area is most common but may be unavailable given limited radiographic evaluation following low-impact injuries. Masseter area has recently been identified as an available alternative and associated with 2-year mortality following injury. We sought to validate this measure and its association with early mortality following severe traumatic brain injury (sTBI) using a retrospective analysis of all geriatric trauma patients with sTBI admitted from 2011-2016 to our trauma center. Admission Glasgow Coma Scale (GCS) score ≤8 was used to identify sTBI. Bilateral masseter area was measured 2 cm below the zygomatic arch and the mean used for analysis. Sarcopenia was defined as mean masseter area one standard deviation or less from the sex-based mean. Multivariate models with logistic regression and Cox proportional hazards test followed univariate analysis. Kaplan-Meier survival curves were generated and evaluated by log rank. The primary outcome of interest was 30-day mortality. A total of 108 patients were identified for inclusion. Twenty-five patients, 16 male and nine female, had sarcopenia with mean masseter areas of 2.81 ± 0.45 cm and 2.24 ± 0.42 cm, respectively. Patients with sarcopenia had significantly increased rates of 30-day mortality (80.0% vs. 50.6%; p = 0.01). Sarcopenia (odds ratio [OR], 2.95; 95% confidence interval [CI] 1.03-8.49) and decreasing masseter area were significantly associated with 30-day mortality (OR, 0.66; 95% CI 0.46-0.95) in multivariate modeling. Masseter area is a readily available and objective measure to determine sarcopenia, which is significantly associated with in-creased 30-day mortality following sTBI.

Pre-Operative Masseter Area is an Independent Predictor of Long-Term Survival after Carotid Endarterectomy

“…The mean MA in these sarcopenic patients was 281 mm 2 in men and 224 mm 2 in women, and they were at increased risk of 30 day mortality (80.0% vs. 50.6%) vs. those with greater MA. 15 This finding is in line with the current analyses, which showed an inverse association between MA and mortality, and suggests that there may be a different threshold for increased mortality according to sex. The present study was not powered to analyse sex differences and the association of MAavg with mortality persisted despite adjustment by sex.…”

“…The finding of an inverse relationship between MAavg and mortality concurs with previous studies which found that MA predicted mortality in elderly patients suffering blunt trauma 14 or traumatic brain injury, 15 and this in turn suggests that MA could be used as a surrogate for sarcopenia. As in the present study, the association was mostly not influenced by age, suggesting that despite correlating with age, MA provides independent prognostic value when predicting death after trauma or CEA.…”

“…13 Similarly, masseter muscle area (MA) measured from CT images predicted mortality and correlated well with psoas muscle area in elderly patients experiencing blunt trauma and traumatic brain injury. 14,15 In line with this, masseter muscle tension, chewing ability, dental status, and physical fitness have been shown previously to be closely associated in elderly care home residents. 16 Sarcopenia related to stroke differs from that related to ageing in that it is characterised by rapid loss of muscle mass, structural alterations in the muscle, and bilateral difference in physical and functional performance determined by the brain lesion, whereas ageing related sarcopenia occurs slowly without structural alterations or bilateral differences.…”

“…As in the present study, the association was mostly not influenced by age, suggesting that despite correlating with age, MA provides independent prognostic value when predicting death after trauma or CEA. In the study by Hu et al, 15 sarcopenia was defined as a decrease in MA of !1 SD from the sex based mean. The mean MA in these sarcopenic patients was 281 mm 2 in men and 224 mm 2 in women, and they were at increased risk of 30 day mortality (80.0% vs. 50.6%) vs. those with greater MA.…”

Feasibility of Using Masticatory Muscles to Assess Skeletal Muscle Mass in Patients with Oral Cavity Cancer

“…In HNC patients, the sarcopenia reflect not only the swallowing function but also the nutritional status [18]. The masticatory muscles were also revealed to be equally valid marker of sarcopenia in trauma patients [19,20]. However, the correlation between masticatory muscle and underlying sarcopenia has never been studied in HNC patients.…”