Abstract
Background The association between sarcopenia at admission and mortality in patients with sepsis has not been comprehensively evaluated. We performed a meta-analysis to systematically evaluate the above association. Methods This meta-analysis included relevant observational studies from Medline, Embase, and Web of Science databases. A random-effect model after incorporation of the intrastudy heterogeneity was selected to pool the results. Subgroup analyses were applied to evaluate the influences of study characteristics on relationship. Results Ten cohort studies including 2396 patients with sepsis were included, and 1496 (62.4%) of them had sarcopenia at presentation. Pooled results showed that compared to those without sarcopenia, septic patients with sarcopenia had a significantly increased early (in-hospital or 1-month) mortality risk (risk ration (RR): 2.14, 95% confidence interval (CI): 1.60–2.87, P < 0.001; I2 = 46%). Subgroup analyses showed consistent association between sarcopenia and increased acute mortality risk in septic patients which were not affected by study characteristics such as study design, country of the study, clinical settings, diagnostic criteria for sepsis, age, gender of the patients, and methods for diagnosis of sarcopenia (P for all subgroup analyses >0.05). Further meta-analyses showed that sarcopenia was also associated with increased mortality risk in septic patients at 3–6 months (RR: 2.13, 95% CI: 1.58–2.89, P < 0.001; I2 = 0%) and at 1 year (RR: 1.57, 95% CI: 1.09–2.24, P = 0.01; I2 = 29%). Conclusions Current evidence suggests that sarcopenia may be a predictor of mortality in patients with sepsis.
Highlights
Sepsis is a common comorbidity in patients with critical illness, which has become a key determinant of the prognosis in these patients [1, 2]
We identified studies by a systematic search of Medline, Embase, and Web of Science electronic databases using the following terms: (1) “sarcopenia” OR “muscle wasting” OR “muscle loss” OR “muscular atrophy” OR “muscle depletion” OR “sarcopaenia” OR “sarcopenic” OR “presarcopenia” OR “sarcopaenic” OR “lean body mass” OR “cross-sectional muscle area” OR “skeletal muscle depletion” OR “muscle mass” OR “muscle index” and (2) “sepsis” OR “septicemia” OR “septic.” Only clinical studies published in English were selected
Inclusion criteria were (1) observational studies published as full-length articles; (2) included adult patients (18 years or above) with confirmed diagnosis of sepsis; (3) sarcopenia identified at presentation and considered as exposure; (4) incidence of mortality was reported as outcome of interest; and (5) reported the association between sarcopenia and the risk of mortality during the follow-up duration. e diagnostic method and criteria of sarcopenia was consistent with the criteria adopted in the original articles
Summary
Sepsis is a common comorbidity in patients with critical illness, which has become a key determinant of the prognosis in these patients [1, 2]. Despite continuous efforts in the prevention of sepsis in critically ill patients, the incidence of sepsis in real-world acute clinical settings remains high, possibly due to multiple factors such as the accelerated aging of the global population, increased use of immunosuppressants, emerged antibiotic resistance, and frequently used invasive monitoring and treatment strategies [3, 4]. Previous studies evaluating the association between sarcopenia at admission and mortality risk in patients with sepsis showed inconsistent results [16,17,18,19,20,21,22,23,24,25]. Erefore, we performed a meta-analysis to systematically evaluate the association between sarcopenia at admission and mortality risk in patients with sepsis The possible association between sarcopenia and early mortality has not been comprehensively evaluated [26]. erefore, we performed a meta-analysis to systematically evaluate the association between sarcopenia at admission and mortality risk in patients with sepsis
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