Increased mortality associated with sarcopenia in inflammatory bowel disease: a long-term prospective cohort study

Background: With gradually increasing number of older inflammatory bowel disease (IBD) patients, a significant number of IBD patients suffer from sarcopenia. Emerging evidence has demonstrated various adverse outcomes associated with sarcopenia, however, the impact of sarcopenia on long-term mortality risk among IBD patients has not yet been explored. Method: Overall, 4,966 IBD patients (aged 56.9±8.0 years, 51.6% female) were enrolled in the prospective cohort. Sarcopenia was assessed according to criteria of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The primary outcome was all-cause mortality. Multivariable Cox proportional hazard model was conducted to estimate related associations. Sensitivity analysis and subgroup analysis were used to validate the results. Results: Overall, 775 (14.6 %) and 34 (0.7 %) were considered probable sarcopenia and confirmed sarcopenia, respectively. During a median follow-up of 14.6 years, 564 all-cause deaths (11.4 %) were identified. There were 136 deaths (17.5 %) among those with probable sarcopenia, and 10 deaths (29.4%) among those with confirmed sarcopenia. Compared with non-sarcopenia those with probable sarcopenia and confirmed sarcopenia had a 47% (hazard ratios HR=1.47, 95% confidence interval CI: 1.20-1.80, P<0.001) and 140% (HR=2.40, 95% CI: 1.27-4.52, P= 0.007) excess risk of mortality, respectively. Similar results were observed in sensitivity analysis. Conclusions: Probable and confirmed sarcopenia increase the risk of long-term mortality in IBD patients. Sarcopenia assessment can help risk stratification for prognosis in older IBD patients.