The impact of computed tomography-assessed sarcopenia on outcomes for trauma patients - a systematic review and meta-analysis

Abstract

Introduction: Sarcopenia is the progressive loss of skeletal muscle mass, strength and general decline in function associated with age, and has previously been shown to be a predictor of poor outcomes following surgery. Computed tomography (CT)-assessed sarcopenia has been proposed to be an independent predictor of outcomes for trauma patients. This systematic review aims to determine the impact of CT-assessed sarcopenia on patient mortality following trauma.

Materials and methods: A systematic review and meta-analysis of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, MEDLINE and CENTRAL databases were searched from database inception to 26 November 2018. Bibliographies of included articles were hand searched for potential articles. All observational studies which included trauma patients who had skeletal muscle mass or density assessed by CT were included in the review. Two authors independently performed the search with decisions reached by consensus. Meta-analysis was performed using Review Manager v5.3 using a random effects model. The primary outcome was all cause mortality, as established a priori.

Results: Following an initial search of 1984 records, a total of 20 retrospective observational studies were included for qualitative analysis. Ten of these studies consisting of a pooled, partly-overlapping, 2867 patients were included in the meta-analysis. There was a wide variation in the reported prevalence of sarcopenia (25.0-71.1%). Sarcopenia patients were at a significantly increased risk of mortality during inpatient stay (RR 1.96 [95%CI 1.30-2.94], p = 0.001), at 30 days (RR 1.60 [95%CI 1.21-2.13], p = 0.001) and at 1-year (RR 3.11 [95%CI 1.94-4.96], p < 0.00001). There was no significant difference in total complications encountered, ICU duration or total inpatient stay.

Conclusion: Sarcopenia identified by CT is associated with increased risk of inpatient, 30-day, and 1-year mortality in trauma patients.

Keywords: Computed tomography; Meta-Analysis; Sarcopenia; Trauma.