Sarcopenia is Predictive of Functional Outcomes in Older Trauma Patients

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.