Sarcopenia and its associated factors among hip fracture patients admitted to a North African (Egyptian) Level one trauma center, a cross-sectional study.

OBJECTIVES

The study's objectives were to assess the sarcopenia prevalence in hip fracture patients admitted to a North African (Egyptian) level one specialized trauma unit and to evaluate factors associated with sarcopenia.

METHODS

This was an analytic, cross-sectional study where patients who were admitted with low-energy hip fractures and managed surgically were included. Assessment was performed using the SARC-F questionnaire, InBody device assessments (skeletal muscle mass (SMM), Fat mass, nutritional status (total water, protein, and minerals)), handgrip strength, and body mass index (BMI). Sarcopenia was diagnosed based on the revised European Working Group on Sarcopenia in Older People criteria (EWGSOP2).

RESULTS

The patients' mean age was 68 ± 8.3 years; 51.9% were females. The mean SMM was 24 ± 4.5 kg, while the mean handgrip strength was 20.55 ± 7.66 kg, sum SARC-F score was normal in 115 (85.2%) patients and abnormal in 20 (14.8%). Based on the EWGSOP2 criteria, 23 (17%) patients had sarcopenia, and 112 (83%) did not. The two groups were comparable regarding age and sex (p = 0.907 and 0.623, respectively). Sarcopenic patients had significantly lower values in BMI (21.9 vs. 25.9 kg/m, p < 0.001), SMM (14.8 vs. 23, p < 0.001), BMR (p < 0.001), Fat mass (18.8 vs. 24.3, p = 0.003), and handgrip strength (16 vs. 20 kg, p = 0.034), however the sum SARC-F score ≥ 4 points, was higher in sarcopenic group (30.4% vs. 11.6%, p = 0.046). SMM, BMR, and fat mass showed large effect sizes (≥ 5), while the handgrip strength showed a medium effect size (0.3). There was a significant negative correlation between patients' age and handgrip strength (r = -0.394, p < 0.001), and a significant positive correlation between BMI and the SMM (r = 0.210, p = 0.014). Univariate logistic regression analysis revealed that the patient's BMI, fat mass, total water, protein, minerals, and the sum of SARC-F were significantly associated with sarcopenia development. However, on multivariate logistic regression analysis, two factors kept a significant association: the protein levels as a marker of nutritional reserve (OR = 0.044, 95%CI = 0.008 to 0.235, P < 0.001) and the sum SARC-F ≥ 4 points as a proxy for functional decline (OR = 6.365, 95%CI = 1.272 to 31.854, P = 0.024).

CONCLUSION

The sarcopenia prevalence in our hip fracture patients was 17%, where BMI, fat mass, and nutritional status had a significant negative association; on the other hand, the sum of SARC-F (≥ 4 points) had a significant positive association. However, after multivariate analysis, only protein levels and the sum of SARC-F remained significantly associated with sarcopenia.