Prognostic Features of Sarcopenia in Older Hospitalized Patients: A 6-Month Follow-Up Study

Abstract

Background: Sarcopenia is associated with adverse health outcomes. Understanding the association between sarcopenia, multidimensional frailty, and prognosis is essential for improving patient care. The aim of this study was to assess the prevalence and prognostic signature of sarcopenia in an acute hospital setting co-led by internists and geriatricians. Methods: Sarcopenia was assessed by applying the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, including the SARC-F score, handgrip strength, bioelectrical impedance analysis (BIA), and Timed Up and Go (TUG) test, to 97 older multimorbid inpatients (76.5 ± 6.8 years, 55% women). The patients underwent a Comprehensive Geriatric Assessment (CGA) including an evaluation of Geriatric Syndromes (GSs) and Resources (GR) and prognosis calculation using the CGA-based Multidimensional Prognostic Index (MPI), European Quality of life-5 Dimensions (EQ-5D-5L) scale, Rosenberg Self-Esteem Scale (RSES), and Geriatric Depression Scale (GDS). Information on survival and rehospitalizations was collected 1, 3, and 6 months after discharge. Results: Sarcopenia was present in 63% (95% CI: 54-72%) of patients and categorized as probable (31%), confirmed (13%), and severe sarcopenia (18%). Sarcopenic patients showed significantly higher median MPI-values (p < 0.001), more GSs (p = 0.033), fewer GR (p = 0.003), lower EQ-5D-5L scores (p < 0.001), and lower RSES scores (p = 0.025) than non-sarcopenic patients. Six months after discharge, being sarcopenic at baseline was predictive of falls (p = 0.027) and quality of life (p = 0.043), independent of age, gender, and MPI. Conclusions: Sarcopenia is highly prevalent in older hospitalized multimorbid patients and is associated with poorer prognosis, mood, and quality of life up to 6 months after discharge, independent of age, sex, and MPI as surrogate markers of biological age.

Keywords: EWGSOP2; MPI; comprehensive geriatric assessment; frailty; older people; prognosis; sarcopenia.

Figure 1

Flow chart for the secondary analysis. Notes: FU = Follow-Up; SARC-F = strength, assistance with walking, rise from a chair, climb stairs, and falls; BIA = Bioelectrical Impedance Analysis.

Figure 2

Flowchart of study population after EWGSOP2 stepwise procedure for the diagnosis of sarcopenia. Notes: SARC-F = strength, assistance with walking, rise from a chair, climb stairs, and falls; BIA = Bioelectrical Impedance Analysis; ASM = Appendicular Skeletal Mass; TUG = Timed Up-and-Go test.

Figure 3

Boxplots showing sarcopenia groups according to EWGSOP2 in association with MPI-prognosis at admission. Notes: MPI = Multidimensional Prognostic Index; PS = Probable Sarcopenia; CS = Confirmed Sarcopenia; SS = Severe Sarcopenia.