Impact of Sarcopenia on outcomes of pulmonary embolism: A systematic review and meta-analysis

Abstract

Background and Objective: Sarcopenia measured by, skeletal muscle mass, has emerged a marker of adverse outcomes in various acute illnesses. Its prognostic significance in patients with acute pulmonary embolism (PE) remains incompletely defined. This systematic review and meta-analysis aimed to evaluate the association between sarcopenia and clinical outcomes in acute PE.

Methodology: A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to December 27, 2025. Observational studies evaluating sarcopenia using computed tomography (CT)-based skeletal muscle parameters in adults with acute PE and reporting mortality or in-hospital outcomes were included. Random-effects meta-analysis was performed when data were amenable to pooling.

Results: Six observational studies comprising 578,886 patients met the inclusion criteria. A pooled analysis of four studies demonstrated that higher skeletal muscle mass or index was associated with a reduced risk of mortality (odds ratio: 0.94; 95% confidence interval: 0.90–0.98), although substantial heterogeneity was observed (I² = 75%) and results were unstable on sensitivity analyses. Descriptive analysis of two studies showed worse in-hospital outcomes in patients with sarcopenia.

Conclusions: The assessment of sarcopenia through CT-derived skeletal muscle measurements may be associated with an increased risk of short-term mortality among patients with acute PE. Quantitative analyses of data also showed a correlation between sarcopenia and adverse outcomes. Methodological heterogeneity and scarce data are important limitations of the review.