Abstract:
Sarcopenia is a progressive loss of skeletal muscle mass, strength and function, and
a leading cause of falls and fractures. Sudden decline in mobility and acute inflammatory
reaction following hip fracture (HF) leads to an acceleration of pre-existing
muscle wasting resulting in poor health outcomes in this vulnerable population.
This study was designed to determine the association between pre-fracture sarcopenia
and short-term mortality among HF patients admitted to National Hospital
Galle (NHG), Sri Lanka. A prospective cohort study was conducted among
370 consecutive patients with incident HF, aged 40 years or more, admitted to
the NHG. Sarcopenia was assessed using the locally validated SARC-F tool soon
after the admission with a score≥ 4 indicating risk of sarcopenia. Patients were
followed up for 30 days, post fracture to evaluate the mortality outcomes through
telephone interviews with family members. Binary logistic regression analysis was
used to examine the association between pre-fracture sarcopenia and short-term
mortality. Ethical approval was obtained from Ethical Review Committee of Faculty
of Medicine, University of Ruhuna. Among 370 subjects, 76% (n=281) were
females, while 65.7% (250) were married. The mean (±SD) age of HF patients
was 75.1 (10.8) years. Of the 370 patients, 31.9% (115) had a risk of sarcopenia
at the time of admission (SARC-F >4) and 9.4% (34) patients died while in the
hospital or within 30 days of HF. The short-term mortality rate was significantly
associated with pre-fracture-sarcopenia of HF patients (p=0.02) and sarcopenia
was a significant predictor of short-term mortality of HF patients. Sarcopenia
remained a strong predictor after adjusting for several confounders such as age,
gender and physical disability (OR= 4.14, 95% CI [1.65,10.38], p=0.002). Prefracture
sarcopenia significantly increases the risk of mortality in HF patients, and
it is a significant predictor of short-term mortality in patients with HF. Therefore,
early detection and targeted interventions should be integrated with the HF
management protocol specially in vulnerable population.
