Sarcopenia, Low Handgrip Strength, and Low Absolute Muscle Mass Predict Long-Term Mortality in Older Hospitalized Patients: An Observational Inception Cohort Study

Objective: Sarcopenia is highly prevalent in hospitalized older patients and associated with short-term mortality. This study aimed to investigate whether sarcopenia and its measures handgrip strength (HGS) and muscle mass at hospital admission were associated with long-term mortality in a cohort of hospitalized older patients. Design: Observational, prospective, longitudinal inception cohort study. Setting and Participants: Academic teaching hospital; patients age >70 years admitted to the internal medicine, acute admission, trauma, or orthopedic wards. Methods: HGS and muscle mass were measured at admission using a hand dynamometer and bioelectrical impedance analysis. Sarcopenia was determined based on the European Working Group on Sarcopenia in Older People definition. HGS and muscle mass (skeletal muscle mass index, appendicular lean mass, relative skeletal muscle mass) were expressed as sex-specific tertiles. The associations of sarcopenia, HGS, and muscle mass with mortality (during a follow-up of 3.4-4.1 years) were analyzed using Cox regression, adjusted for age, sex, comorbidity, and weight or height. Associations of HGS and muscle mass were stratified by sex. Results: Out of 363 patients [mean age: 79.6 years (standard deviation: 6.4), 49.9% female] 49% died. Probable sarcopenia (prevalence of 53.7%) and sarcopenia (prevalence of 20.8%) were significantly associated with long-term mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.08-2.17 and 1.71 95% CI 1.12-2.61, respectively]. Low HGS, skeletal muscle mass index, and appendicular lean mass were associated with a higher mortality risk (lowest tertile vs highest tertile: HR 2.660, 95% CI 1.40-5.05; HR 1.95, 95% CI 1.06-3.58 and HR 1.99 (95% CI 1.12-3.53) in male patients. No statistically significant associations of relative muscle mass with mortality were found. Conclusions and Implications: Sarcopenia and its measures (low HGS and low absolute muscle mass at admission) predict long-term mortality in older hospitalized patients. (c) 2021 Published by Elsevier Inc. on behalf of AMDA -The Society for Post-Acute and Long-Term Care Medicine.

Automated summary

This study found that older patients hospitalized with sarcopenia or probable sarcopenia at admission had a higher risk of long-term mortality. Low handgrip strength, skeletal muscle mass index, and appendicular lean mass were also associated with an increased risk of mortality. The associations of handgrip strength and muscle mass with mortality were influenced by sex.