Review Article

Low Skeletal Muscle Mass and the Incidence of Delirium in Hospitalized Older Patients: A Systematic Review and Meta-Analysis of Observational Studies

Table 1

Characteristics of included studies.

Author; yearCountryStudy designAssessment of skeletal muscle massDefinition of low skeletal muscle massAssessment of deliriumStudy populationNo. of patients (n)NOS quality assessment

Pernik et al. 2022 [15]AmericaRetrospective cohort studyPMI (by CT and MRI)PMI quartile 4A chart review methodPatients ≥65 years old receiving thoracolumbar spine surgery1967
Hwang et al. 2022 [13]South KoreaRetrospective cohort studyAppendicular SMI (by BIA)SMI (males, <7.0 kg/m2; females, <5.7 kg/m2)Based on the diagnostic and statistical manual of mental disorders, 4th editionPatients with a mean age of over 70 years old receiving total knee arthroplasty4528
Zucchelli et al. 2022 [16]ItalyCross-sectional studyBased on the calf circumferenceCalf circumference ≤34 cm for males, ≤33 cm for femalesBased on a 4AT scorePatients with a mean age of 83.1 years old and were admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices16758
van der Zanden et al. 2021 [24]The NetherlandsRetrospective cohort studySMI at the L3 level (by CT)SMI <38.50 cm2/m2Not reportedWomen with a median age of 75.9 (from 70 to 89) years old receiving surgery for ovarian cancer2137
Hirase et al. 2021 [25]AmericaRetrospective cohort studyPMI (by CT and MRI)PMI below the gender specific cut-off values determined using receiver operating characteristic curves and youden indexNot reportedPatients with a mean age of 60.1 years old receiving complex revision thoracolumbar spine surgery1147
Jones et al. 2020 [28]AmericaCase-control studySMI at the L3 level (by CT)SMI ≤41.6 cm2/m2 for males and ≤32.0 cm2/m2 for femalesNot reportedPatients with a mean age of 59.4 years old receiving autologous free tissue reconstruction following resection of head and neck malignancy1686
Mosk et al. 2018 [14]The NetherlandsRetrospective cohort studySMI at the L3 level (by CT)Patients in the lowest sex-specific quartile for skeletal muscle massBased on the delirium observational screening scalePatients with a median age of 76 (from 73 to 80) years old receiving elective surgery for colorectal cancer2518
Bellelli et al. 2018 [27]ItalyCross-sectional studyWhole body SMI (by BIA)SMI of less than 8.87 and 6.42 kg/m2 in men and women, respectivelyBased on the short portable mental status questionnairePatients with a mean age of 80.9 years old and were admitted to the hospital wards5888
Hiraoka et al. 2018 [26]JapanRetrospective cohort studyPMI (by CT)PMI ≤4.24 cm2/m2 for males, ≤2.50 cm2/m2 for femalesBased on the intensive care delirium screening checklistPatients with a mean age of 70.4 years old receiving surgical resection for hepatocellular carcinoma1718

BIA, bioimpedance analysis; CT, computed tomography; MRI, magnetic resonance imaging; NOS, newcastle-ottawa-scale; PMI, psoas muscle index; SMI, skeletal muscle index.