Impact of Sarcopenia on Functional Outcomes Among Patients With Mild Acute Ischemic Stroke and Transient Ischemic Attack: A Retrospective Study

Abstract

IntroductionSarcopenia, a age-related disease characterized by loss of muscle mass accompanied by loss of function, is associated with nutrition imbalance, physical inactivity, insulin resistance, inflammation, metabolic syndrome, and atherosclerosis which are risk factors for cardiovascular disease. However, its association with outcomes after ischemic stroke has not been well-established. This study investigated whether functional outcomes of patients with acute ischemic stroke is associated with sarcopenia.MethodsData were collected from 568 consecutive patients with acute ischemic stroke with National Institute of Health Stroke Scale 0–5 or transient ischemic attack who underwent bioelectrical impedance analysis between March 2018 and March 2021. Sarcopenia was defined, as low muscle mass, as measured by bioelectrical impedance analysis, and low muscle strength, as indicated by the Medical Research Council score. Unfavorable functional outcome was defined as mRS score of 2–6 at 90 days after discharge. The relationship between functional outcomes and the presence of sarcopenia or its components was determined.ResultsOf the 568 patients included (mean age 65.5 ± 12.6 years, 64.6% male), sarcopenia was detected in 48 (8.5%). After adjusting for potential confounders, sarcopenia was independently and significantly associated with unfavorable functional outcome (odds ratio 2.37, 95% confidence interval 1.15–4.73 for unfavorable functional outcome, odds ratio 2.10, 95% confidence interval 1.18–3.71 for an increase in the mRS score). Each component of sarcopenia was also independently associated with unfavorable functional outcome (odds ratio 1.76, 95% confidence interval 1.05–2.95 with low muscle mass, odds ratio 2.64, 95% confidence interval 1.64–4.23 with low muscle strength). The impact of low muscle mass was larger in men than in women, and in patients with lower muscle mass of the lower extremities than in those with lower muscle mass of the upper extremities.ConclusionsIn this study, the prevalence of sarcopenia in patients with stroke was lower than most of previous studies and patients with sarcopenia showed higher likelihood for unfavorable functional outcomes at 90 days after acute ischemic stroke or TIA. Further investigation of the interventions for treating sarcopenia and its impact on the outcome of ischemic stroke patients is needed.

Trajectories of the Prevalence of Sarcopenia in the Pre- and Post-Stroke Periods: A Systematic Review

“…Sarcopenia negatively affects clinical outcomes in patients with stroke. The prevalence of sarcopenia in stroke patients in acute hospitals has been reported to be 8.5–33.8% [ 12 , 13 , 14 , 15 , 16 ], and sarcopenia leads to unfavorable outcomes 90 days after stroke [ 15 ]. In post-acute rehabilitation hospitals, approximately 50% of patients suffer from sarcopenia on admission [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], and sarcopenia inhibits functional recovery and return to home in patients with stroke [ 25 ].…”

Appendicular Skeletal Muscle Mass Associated with Sarcopenia as a Predictor of Poor Functional Outcomes in Ischemic Stroke

“…18 In addition, sarcopenia was diagnosed according to the AWGS and EWGSOP2 criteria based on the DEXA method during early hospitalization in patients with stroke, not limited to mild stroke or TIA. These suggest that the reliability and generalizability of our results are likely to be significantly higher than those of the study by Lee et al 23 Although sarcopenia was initially defined as low muscle mass, there is now a consensus that low muscle mass and low muscle function must be combined to define sarcopenia; therefore, the diagnosis of sarcopenia requires a combined measure of muscle mass, strength, and physical performance. 2,6,24,25 Various indicators are related to muscle mass, such as ASM, skeletal muscle mass index, height, lower extremity skeletal muscle mass, and lower extremity skeletal muscle mass index.…”

Predictive Value of Temporal Muscle Thickness for Sarcopenia after Acute Stroke in Older Patients

“…Appropriate random sampling and reliable results were obtained. Sarcopenia affects the prognosis of patients with stroke [ 4 , 36 , 37 ]. Although it is difficult to measure motor and physical function in patients with stroke due to factors such as paralysis, head CT findings are easily obtainable in clinical practice, and the ability to use TMT for identifying sarcopenia may permit rapid intervention.…”