European Working Group on Sarcopenia in Older People Algorithm: Step-by-Step Relation With Length of Hospitalization

Background: An international consensus is still lacking on the best operational definition of Sarcopenia in hospitalized older adults. The main objective of this study was to use the EWGSOP2 guidelines in hospitalized old subjects to test its predictivity for adverse clinical outcomes and to evaluate its step-by-step capability to predict unfavorable clinical events. Participants and setting: Three hundred and seventeen men and two hundred and eighty seven women, aged 65 to 99 years, consecutively admitted to the Department of Geriatrics at the University Hospital of Verona. Methods: All patients underwent a complete geriatric assessment, clinical evaluation, and for the diagnosis of Sarcopenia, the EWGSOP2 guidelines were applied. As clinical outcomes, length of hospital stay, fall risk, and subjects' quality of life were considered. Results: Among 604 hospitalized older patients, 56.0% presented with a SARC-F score suggestive of a risk for Sarcopenia. Patients at risk for Sarcopenia, and with available handgrip strength data, in 85.5% of cases also presented probable Sarcopenia. Among patients with probable Sarcopenia, and with available body composition data, 83.1% were confirmed with Sarcopenia, with a general prevalence of Sarcopenia of 22%. The shortest average length of hospitalization was in non-sarcopenic patients, with a median of 11 days, whereas dynapenic and sarcopenic subjects have respectively a median of 12 and 13 days of hospitalization, with significant differences also after adjustment for age, nutritional status and comorbidity. After dividing the patients into negative or positive for each diagnostic step of the EWGSOP2 algorithm, we found, for each step of the algorithm, a progressively greater association with adverse clinical outcomes. Conclusions: EWGSOP2 algorithm is a valid tool even in hospitalized older patients, and each step enhances the predictivity of the algorithm; however, SARC-F and muscle strength can still be valuable tools for negative clinical outcomes when body composition data are not available.