Sarcopenia linked to higher acute cholecystitis risk in older adults with incidental gallstones

BackgroundThis study investigated whether sarcopenia independently predicts incident acute cholecystitis (AC) in geriatric patients with gallstones.MethodsThis 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.7ResultsDuring 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.ConclusionsSarcopenia 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.