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Aim <p>To investigate whether low muscle mass is independently associated with adverse clinical outcomes in older adults hospitalized for aspiration pneumonia.</p> Findings <p>Low muscle mass was highly prevalent in this population (89.4%), and severely low muscle mass was independently associated with increased 30-day mortality and readmission. In addition, a clear dose–response relationship was observed, with progressively lower muscle mass corresponding to worse clinical outcomes.</p> Message <p>In older adults hospitalized for aspiration pneumonia, muscle mass assessment on admission may support risk stratification, and promoting awareness and maintenance of muscle health prior to hospitalization may also be important.</p> Purpose <p>Aspiration pneumonia (AP) is highly prevalent in older adults and associated with adverse outcomes. This study aimed to clarify the association between low muscle mass and clinical outcomes in older adults with AP.</p> Methods <p>This cohort study used data from a nationwide claims database in Japan. Participants aged 65–99&#xa0;years hospitalized for AP between April 2014 and November 2024 with a hospital stay of ≥ 3&#xa0;days were included. Appendicular skeletal muscle mass was derived using a validated estimation equation standardized by height<sup>2</sup> and classified using established cutoff values. Low muscle mass was further stratified into moderate and severe categories using time-dependent receiver operating characteristic analysis. The primary outcome was 30-day mortality, and secondary outcomes included readmission. Survival and competing risk models were adjusted for age, sex, comorbidities, and A-DROP scores.</p> Results <p>Overall, 25,611 patients were included (mean age, 85.1&#xa0;years; 59.4% male). Based on the appendicular skeletal muscle mass index (ASMI), 10.6%, 37.2%, and 52.2% of the patients were classified as normal, moderately low, and severely low, respectively. After covariate adjustment, the severely low ASMI group had significantly higher 30-day mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.22–1.63) and readmission risk (subdistribution HR, 1.47; 95% CI, 1.37–1.57) than the normal group.</p> Conclusion <p>Low muscle mass was observed in 89.4% of older adults hospitalized for AP and was independently associated with mortality. These findings underscore the importance of muscle mass assessment, prehospital nutritional care and efforts to maintain muscle health to improve outcomes.</p>

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Low muscle mass as an independent risk factor for 30-day mortality among older inpatients with aspiration pneumonia: a nationwide cohort study

  • 期刊论文

  • 发表日期：

    2026年3月8日

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  • Shuzo Miyahara,
  • Keisuke Maeda,
  • Sahoko Takagi,
  • Tatsuro Inoue

摘要

Aim

To investigate whether low muscle mass is independently associated with adverse clinical outcomes in older adults hospitalized for aspiration pneumonia.

Findings

Low muscle mass was highly prevalent in this population (89.4%), and severely low muscle mass was independently associated with increased 30-day mortality and readmission. In addition, a clear dose–response relationship was observed, with progressively lower muscle mass corresponding to worse clinical outcomes.

Message

In older adults hospitalized for aspiration pneumonia, muscle mass assessment on admission may support risk stratification, and promoting awareness and maintenance of muscle health prior to hospitalization may also be important.

Purpose

Aspiration pneumonia (AP) is highly prevalent in older adults and associated with adverse outcomes. This study aimed to clarify the association between low muscle mass and clinical outcomes in older adults with AP.

Methods

This cohort study used data from a nationwide claims database in Japan. Participants aged 65–99 years hospitalized for AP between April 2014 and November 2024 with a hospital stay of ≥ 3 days were included. Appendicular skeletal muscle mass was derived using a validated estimation equation standardized by height2 and classified using established cutoff values. Low muscle mass was further stratified into moderate and severe categories using time-dependent receiver operating characteristic analysis. The primary outcome was 30-day mortality, and secondary outcomes included readmission. Survival and competing risk models were adjusted for age, sex, comorbidities, and A-DROP scores.

Results

Overall, 25,611 patients were included (mean age, 85.1 years; 59.4% male). Based on the appendicular skeletal muscle mass index (ASMI), 10.6%, 37.2%, and 52.2% of the patients were classified as normal, moderately low, and severely low, respectively. After covariate adjustment, the severely low ASMI group had significantly higher 30-day mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.22–1.63) and readmission risk (subdistribution HR, 1.47; 95% CI, 1.37–1.57) than the normal group.

Conclusion

Low muscle mass was observed in 89.4% of older adults hospitalized for AP and was independently associated with mortality. These findings underscore the importance of muscle mass assessment, prehospital nutritional care and efforts to maintain muscle health to improve outcomes.