Sarcopenic obesity in critically ill patients was associated with significantly higher in-hospital mortality (aOR 4.48), invasive ventilation use (aOR 1.97), and length of stay (+6.4 days).
Does sarcopenic obesity increase in-hospital mortality and resource utilization in adult ICU patients?
Sarcopenic obesity is a highly morbid phenotype in the ICU, associated with a more than 4-fold increase in in-hospital mortality and significantly greater resource utilization.
Introduction: Sarcopenic obesity—a condition marked by the coexistence of obesity and low muscle mass—is increasingly recognized as a high-risk phenotype in critical illness. Despite its potential implications, the prevalence and prognostic significance of this condition in the ICU are not well understood. This study aimed to evaluate the clinical outcomes and healthcare utilization associated with sarcopenic obesity among critically ill patients. Methods: We conducted a retrospective cohort study using the 2022 Nationwide Readmissions Database (NRD). Adult ICU admissions were identified, and sarcopenic obesity was defined using ICD-10 codes for both sarcopenia and obesity. Inverse probability of treatment weighting (IPTW) adjusted for baseline differences. Outcomes included in-hospital mortality, mechanical ventilation, tracheostomy, renal replacement therapy, discharge disposition, length of stay, and hospital charge. Survey-weighted logistic and linear regressions were used to adjust for demographics, comorbidities, and hospital characteristics. Results: Sarcopenia was documented in only 0. 09% of obese patients compared to 1. 57% of non-obese patients—a 17. 5-fold difference. Among 2, 415 patients with sarcopenic obesity, 33. 3% (n=805) needed ICU care. These patients were older (60. 5 vs. 58. 2 years) and less often female (56. 3% vs. 58. 8%). After inverse probability weighting, sarcopenic obesity was linked to higher in-hospital mortality (aOR 4. 48; p< 0. 001), invasive ventilation use (aOR 1. 97; p< 0. 001), tracheostomy (aOR 2. 14; p=0. 020), renal replacement therapy (aOR 1. 44; p=0. 003), and non-home discharge (aOR 2. 60; p< 0. 001). It was also associated with longer hospital stay (+6. 4 days; p< 0. 001) and higher charges (+88, 080; p< 0. 001), highlighting significant clinical and economic burdens. Conclusions: Our study showed that, despite its low documented prevalence, sarcopenic obesity was strongly linked to increased mortality, higher use of life-sustaining therapies, and significantly greater healthcare utilization among ICU patients. Likely underrecognized in obese populations, sarcopenic obesity may be an overlooked high-risk phenotype in critical care. These findings highlight the importance of better identification and targeted interventions to reduce its clinical and economic impacts.
Khan et al. (2026) studied this question. Sarcopenic obesity in critically ill patients was associated with significantly higher in-hospital mortality (aOR 4.48), invasive ventilation use (aOR 1.97), and length of stay (+6.4 days).
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