(1456) Low Muscle Mass Is Associated With Long-Term Disability in Critically Ill Patients With Sepsis

Introduction: Critically ill patients with sepsis account for significant disease morbidity and high healthcare costs. We hypothesized that low muscle mass (LMM) can be used to identify patients who are at risk for late-stage complications following sepsis.

Methods: Prospective cohort analysis of patients treated at a quaternary care medical center over 3 years. Adult, critically ill patients meeting Sepsis-3 criteria and that had a Computed Tomography (CT) scan performed during medical workup were included. LMM was defined by ≤5th percentile of population- and sex-matched skeletal muscle index, measured at the L3 lumbar level (L3SMI). Functional outcomes were assessed at 30 days and 3/6/12 months via phone call.

Results: Of 61 septic and critically ill patients, 21 patients (34%) met criteria for LMM, having a mean L3SMI of 26.5 +/- 4.4 cm2/m2 and 34.0 +/- 5.0 cm2/m2 in females and males, respectively. Mean age of patients with LMM was 75 years (range 31-104 years), 8 (40%) were female, and mean APACHE II score was 21.8 +/- 6.8. LMM was not associated with decreased protein or albumin concentrations at sepsis diagnosis. While LMM was associated with increased mortality on univariate analysis, multivariate logistic regression (factoring age, APACHE II, Charlson Comorbidity Index, and presence of shock) revealed that LMM itself was not associated with increased 30-day or one-year mortality risk. Neither was LMM associated with increased duration of critical illness or hospital length of stay in multivariate analysis. However, it was significantly associated with impaired motor function at one year following sepsis. Specifically, patients with LMM required increased assistance with walking (p=0.044) and with navigating stairs (p=0.044). They also trended toward requiring more help transferring out of bed (p=0.077) and help with ADL’s (p=0.064).

Conclusions: LMM is often used as a surrogate of sarcopenia, in critically ill patients having limited available past medical history. It is not independently predictive of short- or long-term (one-year) mortality, but rather with motor and functional impairment which may be exacerbated by sepsis. This information may guide the need for additional physical rehabilitation in at-risk patients, thus minimizing long-term morbidity.