Sarcopenia is Predictive of Functional Outcomes in Older Trauma Patients

Franchesca Hwang; Christopher M McGreevy; Sri Ram Pentakota; Davis Verde; Joo Hye Park; Ana Berlin; Nina E Glass; David H Livingston; Anne Mosenthal

doi:10.7759/cureus.6154

Sarcopenia is Predictive of Functional Outcomes in Older Trauma Patients

Cureus. 2019 Nov 14;11(11):e6154. doi: 10.7759/cureus.6154.

Authors

Franchesca Hwang¹, Christopher M McGreevy², Sri Ram Pentakota³, Davis Verde⁴, Joo Hye Park⁵, Ana Berlin⁶, Nina E Glass³, David H Livingston³, Anne Mosenthal³

Affiliations

¹ General Surgery, Rutgers New Jersey Medical School, Newark, USA.
² Breast Surgery, University of Pennsylvania, Philadelphia, USA.
³ Surgery, Rutgers New Jersey Medical School, Newark, USA.
⁴ Anesthesiology, Columbia University, New York, USA.
⁵ Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
⁶ Surgery, Columbia University, New York, USA.

Abstract

Introduction: Older patients are more vulnerable to poor outcomes after trauma than younger patients. Sarcopenia, loss of skeletal mass, is prevalent in trauma patients admitted to the intensive care unit (ICU), and it has been shown to correlate with adverse outcomes, such as mortality and ICU days. Yet, little is known whether it predicts other outcomes. We hypothesized that sarcopenia independently predicts poor functional outcomes in older trauma patients admitted to the ICU.

Methods: We performed a retrospective review of patients aged >55 admitted to a surgical ICU in a Level I trauma center for two years. Sarcopenic status was determined by measuring total skeletal muscle cross-sectional area at the L3 level on admission computed tomography (CT), normalized for height with sex-specific cutoffs. Primary outcome measures were in-hospital mortality, functional outcomes measured by the Glasgow Outcome Scale (GOS) at discharge, and discharge disposition. Multivariable logistic regression was used to determine predictors of primary outcomes.

Results: Out of 230 patients, 32% were sarcopenic. The overall mortality was 20%, and 30% were discharged with poor functional outcomes. A higher proportion of sarcopenic patients among survivors had poor functional outcomes at discharge (55% vs. 30%, p=0.002). Sarcopenia was not predictive of in-hospital mortality but was an independent predictor of poor functional outcomes at discharge (OR 2.6; 95% confidence interval [CI] 1.3-5.5), adjusting for age, Glasgow Coma Scale (GCS) on admission, diagnosis of traumatic brain injury (TBI), Injury Severity Score (ISS), and the number of life-limiting illnesses.

Conclusions: Sarcopenia is prevalent in geriatric trauma ICU patients and is an independent predictor of poor functional outcomes. Assessing for sarcopenia has an important potential as a prognostic tool in older trauma patients.

Keywords: functional outcomes; geriatric trauma; glasgow outcome scale; mortality; older trauma patients; sarcopenia; trauma icu.

Grants and funding

Support for this publication was provided by the New Jersey Medical School Hispanic Center of Excellence, Health Resources and Services Administration through Grant D34HP26020 (Dr. Berlin), by the Patient Centered Outcomes Research Institute through Grant PCORI-1502-27462 (Dr. Mosenthal), and by the Auen Foundation (Dr. Hwang).