Dr.med. Dragan Jankovic (Mainz / DE), PD Dr. med. Harald Krenzlin (Mainz / DE), Dr. med. Leon Schmidt (Mainz / DE), Dr. med. Dominik Wesp (Mainz / DE), Prof. Dr. med. Florian Ringel (Mainz / DE), PD Dr. med. Naureen Keric (Mainz / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Objective: Although the relationship between sarcopenia and frailty and clinical outcome in neuro-oncology patients is well established, its potential impact in neurovascular diseases, such as spontaneous subarachnoid hemorrhage (SAH) is unclear. Here we aim to investigate the effect of frailty and sarcopenia, as measured by serum sarcopenia markers, temporal muscle thickness (TMT) and area (TMA), on neurological outcome after SAH.
Methods: Data acquisition was conducted as a single center retrospective analysis. All patients with SAH older than 55 years and treated in our department between 2015 to 2020, were included in our study. Beside the assessment of demographic and routine clinical data (including Hunt&Hess (HH) grade), the Clinical Frailty Score (CFS) was used to determine the frailty of each patient. At the time of admission sarcopenia was evaluated by calculating TMT/TMA on computed tomography (CT) scans and measurement of creatinine and albumin as serum biomarkers. Outcome was assessed using the modified Rankin scale and the Glasgow Outcome Score (GOS) at discharge and the mRS at 12 months follow-up.
Results: 119 consecutive patients were included in our study. 90 patients (75.6%) were female. The mean age of the patients was 63 years (range 55-87). 78 (65.55%) patients were admitted with a moderate sSAH (Hunt and Hess grade 1-3), 41 (34.45%) with severe SAH (Hunt and Hess grade 4-5). The majority of patients had a Fisher score of 4 (69.50%). Patients with TMA <241 cm3 had a significantly lower TMT (P<0.001). In addition, this group of patients had lower creatinine levels (P=0.03) and albumin levels (P=0.08). Patients with a TMT < 5.5 mm were more frail (Mean CFS=4; P=0.04), had a lower GCS (mean GCS=9; P=0.03) and a higher HH (mean HH=3; P=0.009) at admission. Frailty as indicated by a sarcopenic temporal muscle was significantly associated with higher HH grade (P>0.01) and worse neurological outcome (P=0.04) at discharge. Further, hospitalization was prolonged in this group (23±9.2 vs. 27±9.8 days). Multivariate analysis showed that Hunt and Hess scores (p<0.001) and Clinical Frailty Score (p=0.004) were independent predictors of clinical outcome at discharge and at the follow-up.
Conclusion: In this study, frailty and sarcopenia parameters such as TMT and TMA are associated with a more severe SAH grade at admission, with a prolonged hospitalization and a poorer neurological outcome independent from their chronological age.