Clinical and Biochemical diagnostic measures of sarcopenia in trauma and emergency laparotomy elderly patients. (PILOT STUDY)

Abstract

Abstract Background: Sarcopenia is the progressive decline in muscle quality and function attributed to aging. It is a prevalent global problem associated with worse morbidity and mortality outcomes. This risk is even higher in patients who have suffered a major trauma or those requiring an emergency laparotomy as a result of an intra-abdominal injury or to address an acute illness. Therefore, prompt diagnosis of sarcopenia is key to identifying high-risk patients for appropriate management planning and risk mitigation. Computed tomography (CT) remains the current gold standard diagnostic modality. This study aims to interrogate the utility of clinical and biochemical tests in identifying sarcopenia in elderly patients admitted to the hospital for trauma or emergency laparotomy. These measures may provide feasible, cost-efficient, and portable diagnostic tools, complementing or substituting the radiological measures established for diagnosing this condition. Methods: Forty eligible participants aged 65 years or older, admitted to Middlemore hospital for trauma or emergency laparotomy were included in the study. Clinical assessments performed included: midarm muscle circumference (MAMC), Appendicular skeletal muscle mass, handgrip strength (HGS), as well as 2 questionnaires. Thirteen biochemical markers were collected. For all patients who had a CT abdomen in the first week of their admission, the Total Psoas Major Cross-sectional area (TPMCSA) was assessed. The CT scans were conducted pre-operatively where possible as dictated by the patient's hemodynamic stability. Correlations between these measures and morbidity and mortality risks were assessed, in addition to correlations between the clinical and radiological measures. Results: Duke Activity Status Index questionnaire, free triiodothyronine, and Albumin levels correlated with the length of inpatient stay. Some clinical measures including HGS, and MAMC showed a positive correlation with TPMCSA. Similarly, biochemical measures including free triiodothyronine and Brain natriuretic peptide demonstrated correlations with TPMCSA. Conclusion: Some clinical and biochemical measures may prove to be useful surrogates to radiological scans in diagnosing sarcopenia to predict patients’ outcomes in trauma and emergency laparotomy settings.