Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Inclusion and Exclusion Criteria
2.3. Data Analysis
- Socio-demographic, clinical, and geriatric assessment data: age, gender, living situation prior to admission (home or nursing home), body mass index, comorbidities (hypertension, diabetes, heart failure, valvular disease, chronic kidney disease, chronic obstructive pulmonary disease, or history of cerebrovascular disease), polypharmacy (use of >5 medications), basic activities of daily living (ADL), instrumental activities of daily living (IADL), nutritional status (MNA-sf score), comorbidity (CIRS-G score), cognitive impairment, and depression.
- Surgical data: type of fracture (intra- or extracapsular), type of surgical procedure (intramedullary nail, hemiarthroplasty, total hip replacement, triple screw fixation, or plate and screws), delay between admission and surgery (hours), and surgery duration (minutes).
- Biological parameters at admission: hemoglobin, white blood cell count, CRP, albumin, and Vitamin D levels.
- Postoperative complications: the Clavien–Dindo classification was used within 72 h, and the scores were dichotomized into non-severe (grades 1 and 2) and severe (grades 3 to 5) complications [19,20]. Inpatient falls, delirium (detected by at least one positive CAM—Confusion Assessment Method—score), administration of red blood cell transfusions, pressure injuries, and length of stay were also recorded. Inpatient mortality rates were assessed, as well as at 1 month, 3 months, and 6 months post-discharge via electronic health records or contact with the patient’s General Practitioner.
- Sarcopenia assessment: Sarcopenia was defined according to the revised EWGSOP2 criteria [6]. Probable sarcopenia was considered if the maximal grip value of the dominant hand was inferior to 27 kg in men and 16 kg in women. Handgrip strength (HGS) was assessed before surgery when possible, or far from the time of surgery, by two trials of the dominant hand using a standard hand-held dynamometer (JAMAR; TEC; Clifton, NJ, USA), and the maximum value was retained. Sarcopenia was diagnosed as a low grip strength associated with a low muscle mass index. ASMI was measured by DXA, and a low muscle mass was determined by using the cut-off of 5.5 kg/m2 for women and 7.0 kg/m2 for men. Sarcopenia severity was assessed via the mobility component of the MNA-SF, due to the inability of patients to perform physical performance tests postoperatively. This component is considered as a valid to predict gait speed in old, hospitalized patients [21]. The EWGSOP2 categories were dichotomized into two groups: the non-sarcopenic control group including patients with no sarcopenia and probable sarcopenia and the sarcopenia group including confirmed sarcopenia and severe sarcopenia. Rectus femoris thickness was measured using a portable ultrasound device (Clarius PA HD3 Wireless, Belfast, Ireland), with the patient in a supine position, halfway between the anterior superior iliac spine and the superior border of the patella, on the non-fractured leg with the knee extended and relaxed, as according to the recommendations [22]. Measurements were performed by two trained ultrasound operators. Inter-operator reliability was analyzed prior to the study and showed an intraclass correlation coefficient (ICC) between 0.964 and 0.997 (n = 9).
2.4. Statistical Analysis
3. Results
3.1. Descriptive Analysis
3.2. Analysis of the Association Between Rectus Femoris Thickness by POCUS and ASMI by DXA
3.3. Analysis of Factors Associated with Severe Complications and Mortality
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ADL | Activities of Daily Living |
ASMI | Appendicular Skeletal Muscle Mass Index |
AUC | Area Under the Curve |
AWGS | Asian Working Group for Sarcopenia |
BIA | Bioelectrical Impedance Analysis |
BMI | Body Mass Index |
CAM | Confusion Assessment Method |
CI | Confidence Interval |
CIRS-G | Cumulative Illness Rating Scale-Geriatric version |
COPD | Chronic Obstructive Pulmonary Disease |
CRP | C-reactive Protein |
CT | Computed Tomography |
DXA | Dual-energy X-ray Absorptiometry |
EWGSOP | European Working Group on Sarcopenia in Older People |
HGS | Handgrip Strength |
IADL | Instrumental Activities of Daily Living |
ICC | Intraclass Correlation Coefficient |
MNA-SF | Mini Nutritional Assessment-Short Form |
MRI | Magnetic Resonance Imaging |
OR | Odds Ratio |
POCUS | Point-of-Care Ultrasound |
RF | Rectus Femoris |
ROC | Receiver Operating Characteristics |
SPPB | Short Physical Performance Battery |
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Variable | n | n (%) Mean ± SD Median [IQR] |
---|---|---|
Socio-demographic, clinical, and geriatric data | ||
Age (years) | 126 | 85.3 ± 6.6 |
Sex (Men) | 126 | 35 (27.8) |
Place of residence (living at home) | 126 | 77 (61.1) |
BMI (kg/m2) | 126 | 23.0 [20.3–26.0] |
Comorbidities | 126 | |
Hypertension | 86 (68.3) | |
Diabetes | 25 (19.9) | |
Heart failure | 46 (36.5) | |
Moderate to severe valvular disease | 19 (15.1) | |
Chronic kidney disease | 42 (33.3) | |
COPD | 21 (16.7) | |
History of cerebrovascular disease | 23 (18.3) | |
ADL (/24) | 126 | 8 [7–15] |
IADL (/8) | 126 | 2 [0–5] |
MNA-SF (/14) | 126 | 7.8 ± 2.7 |
CIRS-G (/56) | 126 | 16.4 ± 6.2 |
Cognitive impairment | 126 | 55 (43.7) |
Depression | 126 | 36 (28.6) |
Polypharmacy (>5 medications) | 126 | 85 (67.5) |
Surgical characteristics | ||
Type of hip fracture | 126 | |
Intracapsular femoral neck fracture | 65 (51.6) | |
Extracapsular intertrochanteric fracture | 54 (42.8) | |
Extracapsular subtrochanteric fracture | 7 (5.6) | |
Type of surgery | 126 | |
Intramedullary nail | 61 (48.4) | |
Hemiarthroplasty | 52 (41.3) | |
Total hip replacement | 7 (5.6) | |
Triple screw fixation | 5 (3.9) | |
Dynamic hip screw | 1 (0.8) | |
Time from admission to surgery (hours) | 126 | 27 [15–50] |
Duration of surgery (minutes) | 126 | 84 [60–107] |
Laboratory characteristics | ||
Hemoglobin (g/dL) | 126 | 12.2 ± 2.0 |
White blood cell count (×103/mm3) | 126 | 10.7 [8.0–13.8] |
C-reactive protein (mg/L) | 126 | 11.0 [2.0–46.7] |
Albumin (g/L) | 126 | 36.0 [32.0–38.0] |
25 hydroxy-Vitamin D (ng/mL) | 126 | 26.0 [15.3–33.0] |
Postoperative outcomes | ||
Severe complications (Clavien–Dindo score > 2) | 126 | 9 (7.3) |
Fall(s) | 126 | 11 (8.7) |
Delirium | 126 | 24 (19.0) |
Red blood cell transfusion | 126 | 29 (23.0) |
Pressure injury (injuries) | 126 | 12 (9.5) |
Length of hospital stay (days) | 126 | 18 [16–23] |
Mortality | ||
In-hospital | 6 (4.8) | |
At 1 month | 8 (6.3) | |
At 3 months | 20 (16.0) | |
At 6 months | 23 (19.5) |
Variable | n | n (%) Mean ± SD Median [IQR] |
---|---|---|
Handgrip strength (kg) | 123 | 12 [10–20] |
Women | 88 | 12 [8–16] |
Men | 35 | 23 [14–25] |
ASMI (kg/m2) | 103 | 5.5 [5.0–6.4] |
Women | 79 | 5.4 [4.9–6.2] |
Men | 24 | 6.3 [5.4–6.9] |
Sarcopenia according to EWGSOP2 | 100 | |
No sarcopenia | 27 (27) | |
Probable sarcopenia | 30 (30) | |
Confirmed sarcopenia | 28 (28) | |
Severe sarcopenia | 15 (15) | |
Sarcopenia (binary variable) | 100 | 43 (43) |
Women | 76 | 27 (35.5) |
Men | 24 | 16 (66.7) |
Rectus femoris muscle thickness (mm) | 69 | 9.4 ± 3.2 |
Women | 51 | 9.2 ± 3.1 |
Men | 18 | 10.2 ± 3.4 |
Variable | OR | CI 95% | p-Value |
---|---|---|---|
ASMI | 0.80 | [0.34–1.85] | 0.598 |
Rectus femoris muscle thickness | 1.11 | [0.83–1.48] | 0.483 |
Presence of sarcopenia (EWGSOP2) | 0.80 | [0.40–1.56] | 0.508 |
Mortality | In-Hospital | 1 Month | 3 Months | 6 Months | ||||
---|---|---|---|---|---|---|---|---|
N (%) | 6 (4.8%) | 8 (6.3%) | 20 (16%) | 23 (19.5%) | ||||
OR [95%] | p | OR [95%] | p | OR [95%] | p | OR [95%] | p | |
ASMI | 0.07 [0.004–1.10] | 0.058 | 0.66 [0.23–1.89] | 0.436 | 0.84 [0.48–1.47] | 0.540 | 1.14 [0.65–2.02] | 0.641 |
RF thickness | 0.78 [0.46–1.33] | 0.361 | 0.86 [0.58–1.29] | 0.471 | 0.81 [0.65–1.01] | 0.062 | 0.82 [0.64–1.06] | 0.126 |
Presence of sarcopenia (EWGSOP2) | NA | NA | NA | NA | 0.36 [0.09–1.38] | 0.135 | 0.44 [0.11–1.76] | 0.248 |
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Mondo, L.; Louis, C.; Saboul, H.; Beernaert, L.; De Breucker, S. Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture. J. Clin. Med. 2025, 14, 5424. https://doi.org/10.3390/jcm14155424
Mondo L, Louis C, Saboul H, Beernaert L, De Breucker S. Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture. Journal of Clinical Medicine. 2025; 14(15):5424. https://doi.org/10.3390/jcm14155424
Chicago/Turabian StyleMondo, Laure, Chloé Louis, Hinda Saboul, Laetitia Beernaert, and Sandra De Breucker. 2025. "Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture" Journal of Clinical Medicine 14, no. 15: 5424. https://doi.org/10.3390/jcm14155424
APA StyleMondo, L., Louis, C., Saboul, H., Beernaert, L., & De Breucker, S. (2025). Diagnostic Value of Point-of-Care Ultrasound for Sarcopenia in Geriatric Patients Hospitalized for Hip Fracture. Journal of Clinical Medicine, 14(15), 5424. https://doi.org/10.3390/jcm14155424