The importance of sarcopenia in the prediction of outcomes of acute cerebral insufficiency in patients with post-intensive care syndrome: descriptive prospective cohort study

INTRODUCTION: Patients with acute cerebral insufficiency (ACI) are at high risk of developing the post-intensive care syndrome (PICS), an important role in the formation of which is played by sarcopenia. OBJECTIVE: To study the prognostic significance of sarcopenia in the development and severity of PICS in patients with acute ACI. MATERIALS AND METHODS: A prospective single-center cohort study included 115 patients with ACI due to ischemic (IS) or hemorrhagic stroke (GI). The level of consciousness, severity of neurological deficit, multiple organ dysfunction, PICS on days 3 and 7, duration of mechanical ventilation, and the presence of sarcopenia were assessed. To assess the independent effect of sarcopenia on 28-day mortality, a multifactorial logistic regression analysis was performed. RESULTS: The prevalence of sarcopenia in patients with PICS and ACI was 61.8 %. Patients with sarcopenia were characterized by a more pronounced neurological deficit and the severity of ACI at admission (p < 0.001). Patients with sarcopenia had a more severe course of PICS on day 3 — 3 (2.0; 4.0) points (p = 0.014) and on day 7 — 5 (4; 5.5) points (p < 0.001). Sarcopenia was associated with a high number of complications: pneumonia — 67.6 % (p < 0.001) and sepsis — 31.0 % (p = 0.016), as well as a mortality rate of 42.3 % (p = 0.033) with a mortality rate of more than 28 days. Ventilation in the sarcopenia group was performed in 84.5 % of patients (p = 0.002). CONCLUSIONS: Sarcopenia in patients with ACI and PIСS is associated with a more severe course of PICS, a greater number of complications (pneumonia, sepsis), the need for ventilation, and a higher 28-day mortality rate. With the severity of PICS on day 7 from 3 to 7 points, the probable mortality is significantly higher in patients with sarcopenia.