The impact of sarcopenia and acute muscle mass loss on long‐term outcomes in critically ill patients with intra‐abdominal sepsis

Abstract

Background Sarcopenia is a known risk factor for poor outcomes across many chronic diseases. The impact on outcomes of both pre-existing sarcopenia and acute muscle wasting (AMW) in acute critical illness caused by sepsis remain unclear. Methods We conducted a prospective longitudinal cohort study of critically ill patients with intra-abdominal sepsis utilizing abdominal computed tomography at sepsis onset to determine baseline skeletal muscle index (SMI). Biomarkers of inflammation and catabolism were measured through 28 days while hospitalized. We performed follow-up evaluations of strength and physical function at 3, 6, and 12 months, with interval CT analyses at 3 and 12 months to evaluate changes in muscle mass. Measured clinical outcomes included development of chronic critical illness (≥14 days in intensive care with persistent organ dysfunction), long-term functional status, and 1 year mortality. Results Among 47 sepsis patients enrolled (mean age 53 ± 14 years), half (n = 23; 49%) were sarcopenic at baseline. Overall, sepsis patients exhibited acute and persistent muscle wasting with an average 8% decrease in SMI from baseline at 3 months (P = 0.0008). Sarcopenic (SAR) and non-sarcopenic (NSAR) groups were similar in regards to age and comorbidity burden. SAR patients had greater acute physiologic derangement (APACHE II, 18 vs. 12.5), higher incidence of multiple organ failure (57% vs. 17%), longer hospital (21 vs. 12 days) and intensive care unit length of stays (13 vs. 4 days), and higher inpatient mortality (17% vs. 0%; all P < 0.05). Pre-existing SAR was a strong independent predictor of early death or developing chronic critical illness (odds ratio 11.87, 95% confidence interval CI 1.88-74.9; P = 0.009, area under the curve 0.880) and was associated with significantly higher risk of 1-year mortality (34.9% vs. 4.2%, p = 0.007). Lower baseline SMI was also predictive of poor functional status at 12 months (OR 0.89, 95% confidence interval 0.80-0.99; p = 0.039, area under the curve 0.867). Additionally, SAR patients had AMW with persistent muscle mass loss at 3 months that was associated with decreased health-related quality of life and SF-36 physical function domains (P < 0.05). Persistent AMW at 3 months was not predictive of mortality or poor functional status, with return to near-baseline muscle mass among sepsis survivors by 6 months. Conclusions Critically ill patients have an acute and persistent loss of muscle mass after intra-abdominal sepsis, which is associated with decreased health-related quality of life and physical function at 3 months. However, pre-existing sarcopenia, rather than persistent acute muscle mass loss at 3 months after sepsis, is independently associated with poor long-term functional status and increased 1 year mortality.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment

“…We were able to identify low muscle mass using CT scans in 48% of our population, which is a lower frequency compared to the 65% reported in an Italian cohort using different cut-off values for low muscle identification (45.4 cm 2 /m 2 for males and 34.4 cm 2 /m 2 for females) [38]. In critically-ill septic patients, Cox Mc et al, reported a prevalence of baseline low muscle mass in 50% of patients [39]. Another study in hospitalized patients with COVID-19 showed that muscle mass was related to the need for ICU admission (17%), longer hospital LOS (mean, 10.8 days), and mortality (6.6%) [40].…”

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

“…As given in Table 1 , 10 cohort studies [ 16 – 25 ] including 2396 adult patients with sepsis were included in the meta-analysis. These studies were published between 2017 and 2021 and performed in Japan [ 16 , 18 , 25 ], Korea [ 19 , 21 – 23 ], China [ 17 ], Italy [ 20 ], and the United States [ 24 ]. All of the included studies were retrospective cohort studies, except for one study, which was a prospective cohort study [ 24 ].…”

“…These studies were published between 2017 and 2021 and performed in Japan [ 16 , 18 , 25 ], Korea [ 19 , 21 – 23 ], China [ 17 ], Italy [ 20 ], and the United States [ 24 ]. All of the included studies were retrospective cohort studies, except for one study, which was a prospective cohort study [ 24 ]. The studies included patients with sepsis admitted in emergency department or intensive care unit diagnosed with the sepsis-1 [ 20 ], sepsis-2 [ 17 ], and sepsis-3 criteria [ 16 , 18 , 19 , 21 – 25 ], respectively.…”

“…Subgroup analyses showed consistent association between sarcopenia and increased early 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, methods for diagnosis of sarcopenia, in in-hospital and 1-month mortality, and in different quality scores ( P for all subgroup analyses >0.05; Table 3 ). Further meta-analyses showed that sarcopenia was also associated with increased mortality risk in septic patients at 3–6 months (3 studies [ 19 , 22 , 25 ], RR: 2.13, 95% CI: 1.58–2.89, P < 0.001; I 2 = 0%; Figure 2(b) ) and at 1 year (three studies [ 21 , 24 , 25 ], RR: 1.57, 95% CI: 1.09–2.24, P = 0.01; I 2 = 29%; Figure 2(c) ) after discharge.…”

Prevalence and prognostic value of preexisting sarcopenia in patients with mechanical ventilation: a systematic review and meta-analysis

“…Furthermore, in contrast to present acute illness, sarcopenia is understudied in ICU settings. However, baseline LMM has been demonstrated to be a risk factor for poor prognosis in other diseases, including esophageal cancer [ 48 ], chronic obstructive pulmonary disease [ 49 ], and sepsis in critically ill patients [ 50 ]. Our review adds to the growing body of evidence suggesting that LMM is a strong predictor of poor outcomes among patients with MV.…”