Long-Term Outcomes in Septic Critically Ill Patients With Preexisting Sarcopenia

Sunday, January 22, 2023

2:30 PM – 3:30 PM PT

Location: Exhibit Hall - RST 01

First Author(s)

Nola Darden (she/her/hers)

n/a

Disclosure information not submitted.

Co-Author(s)

Benjamin W. Mancini, BS (he/him/his)

Medical Student (MS4)
Penn State Health, Milton S Hershey Medical Center
Hershey, Pennsylvania, United States

Disclosure information not submitted.
KK

Kunal Karamchandani, MD, FCCP, FCCM

Associate Professor
University of Texas Southwestern Medical Center
Dallas, United States

Disclosure information not submitted.
AB

Anthony S. Bonavia, MD

Associate Professor
Pennsylvania State Milton S Hershey Medical Center, United States

Disclosure information not submitted.

INTRODUCTION: Pre-admission sarcopenia and muscle wasting comorbidities has been associated with negative short term outcomes in critically ill patients. There is limited evidence if they also have an impact on long term outcomes especially in patients with sepsis. We hypothesized that sarcopenia independently predicts poor, long term outcomes in patients with critical illness secondary to sepsis.

METHODS : We conducted a single-center, retrospective cohort analysis of 101 critically ill, adult patients with sepsis that had an abdominal CT scan within 7 days of hospital admission. Skeletal muscle index was measured at the 3rd lumbar level on imaging. Sarcopenia was defined as a gender-matched muscle area index of < 5th percentile of the population. Our primary outcome of interest was 1-year mortality. Secondary outcomes included intensive care unit (ICU) length of stay, post-discharge disposition, and hospital readmission rates.

RESULTS: Of the 101 patients meeting inclusion criteria, mean SOFA score was 5.9 ± 3.3 and mean APACHE II score was 15 ± 6.6. Sarcopenia was detected in 21 patients and the mortality rate for the cohort was 20%. In bivariate analysis, sarcopenia did not predict mortality rate, ICU length of stay, hospital length of stay for the index admission, the likelihood of hospital readmission, or hospital length of stay for patients who required hospital readmission. On multivariate analysis, skeletal muscle area and skeletal muscle index correlated with mortality but did not reach statistical significance (p=0.07 and p=0.09, respectively). There was no significant relationship between body mass index and post-hospitalization disposition. Survivors with sarcopenia were more likely to be discharged home (N=4, p=0.014) and less likely to be discharged to hospice care (N=10, p=0.022) following hospitalization for sepsis.

CONCLUSIONS: We did not find any association between sarcopenia and poor long-term outcomes in critically ill patients with sepsis. While sarcopenia has been associated with increased 1-year mortality following abdominal sepsis, our study did not distinguish between different sources of sepsis, and it did not replicate these prior results. Further studies are needed to validate our findings in a larger patient sample.