Comprehensive Review of Sepsis-Related Skeletal Muscle Atrophy: Mechanisms, Diagnosis and Therapeutic Strategies

This comprehensive review aims to synthesize current evidence on sepsis-related skeletal muscle atrophy, with a focus on underlying mechanisms, diagnostic approaches, and therapeutic interventions. A systematic literature search was conducted in PubMed, Web of Science, and Cochrane Library up to October 2024, including clinical, translational, and animal studies. We critically analyzed the pathophysiological mechanisms linking sepsis to muscle wasting, including inflammatory signaling, mitochondrial dysfunction, and proteolytic pathways. Epidemiological data indicate a high incidence of muscle atrophy in sepsis patients, particularly among the elderly and those with comorbidities. Diagnostic modalities such as CT, MRI, ultrasound, and emerging biomarkers including urinary titin and myokines are discussed. Treatment strategies encompassing nutritional support, pharmacotherapy (eg, GLP-1RAs, myostatin inhibitors), and rehabilitation are evaluated. Controversies regarding etiology and treatment efficacy are highlighted. Future directions include the exploration of novel biomarkers, genomics-based personalized therapy, and long-term outcome studies. This review provides a structured and critical appraisal of the current state of knowledge, aiming to inform clinical practice and future research.