Temporal muscle thickness as a feasible sarcopenia marker and outcome predictor after aneurysmal subarachnoid hemorrhage

Background and Purpose Sarcopenia has already been investigated as a prognostic marker for many different cancerous and non-cancerous diseases to prognosticate the clinical course. While being a sarcopenia marker, temporal muscle thickness (TMT) has gained increasing interest in recent years as a potential outcome predictor. The aim of this retrospective study was to investigate the association between TMT and the neurological outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective database consisting of consecutive aSAH cases treated from 01/2003 to 06/2016 was used. The initial computed tomography examinations were used to calculate the mean TMT values. Our primary endpoint was unfavorable outcome at 6 months defined as modified Rankin Scale > 3. Secondary endpoints included the occurrence of angiographic vasospasm and intracranial hypertension (> 20mmHg) during aSAH, in-hospital mortality and development of cerebral infarcts. Univariable analyses were conducted and multivariable analyses were performed on significant findings. Results The mean TMT value of the final cohort (n = 945) was 7.49mm +/- 1.68mm. Of the baseline characteristics, a significant relationship with TMT mean value was found for age (p < 0.0001), sex (p < 0.0001), obesity (p = 0.001), hypothyroidism (p = 0.001), and hyperuricemia (p = 0.026). In the final multivariable analysis, the following study endpoints were independently associated with mTMT: in-hospital mortality (p = 0.035, adjusted odds ratio [aOR] 0.86 per-mm-increase, 95% confidence interval [CI] 0.75-0.99), unfavorable outcome at 6 months (p = 0.018, aOR 0.86, 95% CI 0.76-0.98), intracranial hypertension (p = 0.002, aOR 1.17, 95% CI 1.06-1.29) and the occurrence of angiographic vasospasm (p = 0.011, aOR 0.87, 95% CI 0.78-0.97). Conclusions In this study, we found significant correlations between mTMT and the clinical course and outcome of patients with aSAH. Further studies in different patient populations are needed to validate the clinical relevance and prognostic value of TMT for aSAH patients.