Absolute and relative temporal muscle volume and one-year all-cause mortality in older adults with stroke

Temporal muscle measurements from cranial CT scans have been proposed as surrogate markers of sarcopenia and predictors of poor outcomes in older adults with acute ischemic stroke. However, the prognostic value of temporal muscle volume (TMV), especially in diverse populations, remains unclear. We aimed to evaluate whether temporal muscle morphometry predicts one-year mortality in older adults admitted to the hospital with ischemic stroke. This retrospective cohort study included patients aged ≥ 60 years admitted with acute ischemic stroke at a tertiary hospital in Bogotá, Colombia. TMV was measured from baseline CT scans using manual segmentation. Volume was represented as both an absolute and a relative value (adjusted by height and BMI). Sex-specific cut-offs were defined using maximally selected rank statistics. Cox proportional hazards models (adjusted for age and NIHSS) assessed associations between muscle parameters and one-year all-cause mortality. Assumptions of proportionality were tested using Schoenfeld residuals. Kaplan–Meier curves and log-rank tests were used to evaluate survival differences. Among 376 participants (median age 77, 51% female), one-year mortality was 23%. TMV was lower in deceased patients. However, none of the TMV-based variables predicted mortality. Elevated NIHSS remained a strong predictor of mortality in all models (adjusted HR ~ 3.5). TMV was not a significant predictor of 1-year mortality after stroke. Stroke severity remains the most robust predictor of mortality in older adults; however, further research is needed to clarify the prognostic role of TMV in post-stroke functional recovery and survival.