Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Abstract

Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

Low‐cost and fast‐performing indicators of muscle mass loss are good predictors of clinical outcomes in hospitalized patients: A longitudinal observational study

“…Further, in a large prospective multicenter cohort study, 37 MAMC was not associated with longer LOS (OR = 0.98; 95% CI, 0.96–1.01) or 30 days readmission (OR = 0.98; 95% CI, 0.95–1.01). In agreement with our results, Anani et al 38 prospectively assessed 980 individuals and demonstrated that MAMC values were not correlated with patients’ LOS or risk for 30 days readmission.…”

Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts

“…We screened 14,006 abstracts and 2287 full texts, from which 45 cohorts (n = 39,041,266 admissions, 49 publications) 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 were eligible for inclusion ( Fig. 1 ).…”

Sarcopenia and Frailty in Heart Failure: Is There a Biomarker Signature?

“…Alanine transaminase (ALT), which is abundant in the liver and facilitates the conversion of pyruvate to the amino acid alanine, is an accessible and inexpensive biochemical assay that primarily monitors cellular and hepatic damage in the clinical setting. On the other hand, when the liver parenchyma is intact, ALT plasma levels are a good marker of systemic skeletal muscle mass and muscle strength [109]. Low ALT has also been reported to be a surrogate marker of malnutrition [80], and numerous studies accumulated the evidence that lower ALT levels may be reliable markers of sarcopenia and frailty in a variety of populations [110,111].…”