Sarcopenia As a Robust Predictor of Readmission Within 6 Months Among Individuals Experiencing Acute Stroke

Overview

Journal Ann Geriatr Med Res

Specialty Geriatrics

Date 2024 Apr 11

PMID 38600867

Authors

Takafumi Abe

Yoshihiro Yoshimura

Yoichi Sato

Fumihiko Nagano

Ayaka Matsumoto

Affiliations

Soon will be listed here.

Abstract

Background: Sarcopenia negatively affects the short-term prognosis of hospitalized older adults. However, no evidence currently supports a direct relationship between sarcopenia and readmission among individuals who have experienced an acute stroke. Therefore, we investigated whether sarcopenia is associated with readmission after discharge.

Methods: This retrospective cohort study included patients who had experienced acute stroke. Sarcopenia was defined as the coexistence of low skeletal muscle mass index (SMI) and grip strength. We applied the log-rank test and Cox proportional hazards regression analysis to analyze whether sarcopenia, low SMI, and low grip strength were associated with readmission within 6 months.

Results: Among 228 included patients (mean age, 72.8 years; 146 males), the prevalence of sarcopenia was 24.6% (n=56; male 17.8%; female 36.6%). Cox proportional hazards regression analysis using the propensity score as a covariate revealed that sarcopenia (hazard ratio [HR]=7.21; 95% confidence interval [CI] 1.45-35.8; p=0.016) and low skeletal muscle mass (HR=7.40; 95% CI 1.14-48.1; p=0.036), but not low grip strength (HR=1.42; 95% CI 0.281-7.21; p=0.670), were significantly associated with readmission for stroke within 6 months.

Conclusions: Sarcopenia was negatively associated with readmission within 6 months of stroke onset in patients in Japan who had experienced an acute stroke. These findings suggest that the identification of sarcopenia may facilitate prognostic prediction from the acute stage and intervention(s) to prevent rehospitalization.

References

Gariballa S, Alessa A . Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr. 2013; 32(5):772-6. DOI: 10.1016/j.clnu.2013.01.010. View

Chen L, Woo J, Assantachai P, Auyeung T, Chou M, Iijima K . Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020; 21(3):300-307.e2. DOI: 10.1016/j.jamda.2019.12.012. View

Rao A, Barrow E, Vuik S, Darzi A, Aylin P . Systematic Review of Hospital Readmissions in Stroke Patients. Stroke Res Treat. 2016; 2016:9325368. PMC: 5030407. DOI: 10.1155/2016/9325368. View

Yoshimura Y, Wakabayashi H, Bise T, Tanoue M . Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients. Clin Nutr. 2017; 37(6 Pt A):2022-2028. DOI: 10.1016/j.clnu.2017.09.009. View

Gardener H, Leifheit E, Lichtman J, Wang K, Wang Y, Gutierrez C . Race-Ethnic Disparities in 30-Day Readmission After Stroke Among Medicare Beneficiaries in the Florida Stroke Registry. J Stroke Cerebrovasc Dis. 2019; 28(12):104399. PMC: 6939298. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104399. View

Fairchild A, McDaniel H . Best (but oft-forgotten) practices: mediation analysis. Am J Clin Nutr. 2017; 105(6):1259-1271. PMC: 5445681. DOI: 10.3945/ajcn.117.152546. View

Rumball-Smith J, Hider P . The validity of readmission rate as a marker of the quality of hospital care, and a recommendation for its definition. N Z Med J. 2009; 122(1289):63-70. View

Kanda Y . Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2012; 48(3):452-8. PMC: 3590441. DOI: 10.1038/bmt.2012.244. View

Xu J, Zhang X, Jin A, Pan Y, Li Z, Meng X . Trends and Risk Factors Associated With Stroke Recurrence in China, 2007-2018. JAMA Netw Open. 2022; 5(6):e2216341. PMC: 9201671. DOI: 10.1001/jamanetworkopen.2022.16341. View

10.

Wang S, Zhu X . Nationwide hospital admission data statistics and disease-specific 30-day readmission prediction. Health Inf Sci Syst. 2022; 10(1):25. PMC: 9439279. DOI: 10.1007/s13755-022-00195-7. View

11.

Zhao Y, Zhang Y, Hao Q, Ge M, Dong B . Sarcopenia and hospital-related outcomes in the old people: a systematic review and meta-analysis. Aging Clin Exp Res. 2018; 31(1):5-14. DOI: 10.1007/s40520-018-0931-z. View

12.

Nozoe M, Kanai M, Kubo H, Yamamoto M, Shimada S, Mase K . Prestroke sarcopenia and functional outcomes in elderly patients who have had an acute stroke: A prospective cohort study. Nutrition. 2019; 66:44-47. DOI: 10.1016/j.nut.2019.04.011. View

13.

Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J, Nicolis I . Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005; 82(4):777-83. DOI: 10.1093/ajcn/82.4.777. View

14.

Ottenbacher K, Graham J, Ottenbacher A, Lee J, Al Snih S, Karmarkar A . Hospital readmission in persons with stroke following postacute inpatient rehabilitation. J Gerontol A Biol Sci Med Sci. 2012; 67(8):875-81. PMC: 3403861. DOI: 10.1093/gerona/glr247. View

15.

Konishi M, Kagiyama N, Kamiya K, Saito H, Saito K, Ogasahara Y . Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction. Eur J Prev Cardiol. 2021; 28(9):1022-1029. DOI: 10.1093/eurjpc/zwaa117. View

16.

Tay M . Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort. J Rehabil Med. 2021; 53(6):jrm00208. PMC: 8814857. DOI: 10.2340/16501977-2849. View

17.

Bjerkreim A, Naess H, Khanevski A, Thomassen L, Waje-Andreassen U, Logallo N . One-year versus five-year hospital readmission after ischemic stroke and TIA. BMC Neurol. 2019; 19(1):15. PMC: 6352360. DOI: 10.1186/s12883-019-1242-5. View

18.

Ng M, Hill K, Batchelor F, Burton E . Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil. 2017; 98(12):2433-2441. DOI: 10.1016/j.apmr.2017.05.018. View

19.

Andrews A, Li D, Freburger J . Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission. Phys Ther. 2015; 95(12):1660-7. DOI: 10.2522/ptj.20140610. View

20.

Nagayama H, Tomori K, Ikeda K, Yamauchi K . Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data. J Am Med Dir Assoc. 2021; 22(8):1762-1766.e1. DOI: 10.1016/j.jamda.2020.12.015. View