Prognostic value of sarcopenia markers in geriatric patients presenting to the emergency department: a prospective study.

Abstract

Background: Early risk stratification in geriatric patients presenting to the emergency department remains challenging. Sarcopenia has emerged as a potential marker of reduced physiological reserve and adverse clinical outcomes. This study aimed to evaluate the prognostic value of quadriceps muscle thickness and the paraspinal muscle index for predicting short-term mortality in geriatric emergency department patients and to examine their association with established frailty scales.

Methods: In this single-center prospective observational study, consecutive patients aged ≥ 65 years presenting to the emergency department were enrolled. Rectus femoris and vastus intermedius muscle thicknesses were measured using bedside ultrasonography. The paraspinal muscle index was calculated from thoracic computed tomography images obtained for clinical indications. Frailty was assessed using the Clinical Frailty Scale (CFS), Elderly Risk Assessment (ERA), and Identification of Seniors at Risk (ISAR). The primary outcome was 30-day mortality. Receiver operating characteristic (ROC) analysis was performed to evaluate discriminatory performance.

Results: A total of 139 patients were included, of whom 28 (20.1%) died within 30 days. All sarcopenia indices were significantly lower among non-survivors (p < 0.05). In ROC analysis, the paraspinal muscle index demonstrated the highest discriminatory ability for predicting 30-day mortality (AUC 0.689, 95% CI 0.584-0.795), followed by the vastus intermedius (AUC 0.633) and rectus femoris indices (AUC 0.628). In subgroup analysis, quadriceps indices were associated with mortality only in non-inflammatory patients, whereas the paraspinal muscle index remained predictive across both groups. Among frailty tools, only CFS was significantly associated with mortality.

Conclusion: Muscle-based sarcopenia markers, particularly the paraspinal muscle index, are associated with short-term mortality in geriatric emergency department patients. Integration of muscle measurements with frailty assessment may enhance early risk stratification in emergency care settings.