Sarcopenia independently predicts acute cholecystitis in older patients with gallstones: a retrospective cohort study

This study investigated whether sarcopenia independently predicts incident acute cholecystitis (AC) in geriatric patients with gallstones.

This retrospective cohort study included 1,177 patients aged ≥65 years with incidentally detected gallstones and no prior biliary disease. Sarcopenia was diagnosed using Asian Working Group for Sarcopenia 2019 criteria. The primary outcome was AC development during follow-up, adjudicated using Tokyo Guidelines 2018. Multivariate logistic and Cox regression models adjusted for age, BMI, sex, alcoholism, and Charlson Comorbidity Index.7.

During follow-up, 336 patients (28.5%) developed AC. The AC group exhibited significantly higher sarcopenia prevalence (38.10 vs. 14.03%; p < 0.001) and lower mean handgrip strength (22.92 ± 12.51 vs. 25.50 ± 12.44 kg; p < 0.001) and appendicular skeletal muscle mass (6.82 ± 2.74 vs. 7.67 ± 2.93 kg/m²; p < 0.001) compared to controls. Sarcopenia independently increased AC risk by 3.56-fold (OR = 3.564, 95%CI: 2.619-4.860; p < 0.001) and AC hazard by 2.42-fold (HR = 2.419, 95%CI: 1.912-3.060; p < 0.001). Kaplan-Meier analysis demonstrated significantly reduced AC-free survival in sarcopenic patients (log-rank p < 0.001). Severe sarcopenia did not confer additional risk beyond standard sarcopenia criteria.

Sarcopenia is a robust, independent predictor of AC development in older adults with gallstones, offering superior risk stratification compared to adiposity-based metrics. Routine sarcopenia assessment may identify high-risk individuals for targeted preventive interventions.