入院高齢患者のサルコペニアと予後

入院患者におけるサルコペニアの有病割合と予後的意義に関する論文を紹介します。

Salah Gariballa, Awad Elessa. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clinical Nutrition, published online 01 February 2013, doi:10.1016/j.clnu.2013.01.010

対象は急性疾患で入院した高齢者432人です。入院72時間後、6週間後、6ヶ月後の3回評価しました。サルコペニアの有無はEWGSOPの診断基準で評価しました。結果ですが、432人中44人（10%）にサルコペニアを認めました。

サルコペニアを認めた患者は、より高齢で、抑うつ症状を認め、血清アルブミンが低値でした。入院期間はサルコペニア患者で有意に長かったです。6ヶ月後の再入院のリスクと死亡率は、サルコペニアを認めない患者で有意に低かったです。

以上より急性疾患で入院した高齢者にサルコペニアを認める場合、臨床的な予後が悪いという結論です。当院でも入院リハを要する高齢者にサルコペニアをしばしば認めますが、リハ期間が長く機能予後が悪い印象ですので、納得できる結果です。次はリハ栄養介入ですね。

Summary

Background

Sarcopenia is prevalent in older populations with many causes and varying outcomes however information for use in clinical practice is still lacking.

Aims

The aim of this report is to identify the clinical determinants and prognostic significance of sarcopenia in a cohort of hospitalized acutely ill older patients.

Methods

Four hundred and thirty two randomly selected patients had their baseline clinical characteristic data assessed within 72 hours of admission, at 6 weeks and at 6 months. Nutritional status was assessed from anthropometric and biochemical data. Sarcopenia was diagnosed from low muscle mass and low muscle strength-hand grip using anthropometric measures based on the European Working Group criteria.

Results

Compared with patients without sarcopenia, those diagnosed with sarcopenia 44 (10%) were more likely to be older, have more depression symptoms and lower serum albumin concentration. The length of hospital stay (LOS) was significantly longer in patients diagnosed with sarcopenia compared with patients without sarcopenia [mean (SD) LOS 13.4 (8.8) versus 9.4 (7) days respectively, p = 0.003]. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients without sarcopenia compared with those diagnosed with sarcopenia (adjusted hazard ratio 0.53 (95% CI: 0.32 to 0.87, p = 0.013). The death rate was also lower in patients without sarcopenia 38/388 (10%), compared with those with sarcopenia 12/44 (27%), p-value = 0.001

Conclusion

Older people with sarcopenia have poor clinical outcome following acute illness compared with those without sarcopenia.