Association between sarcopenia and mortality in older adults with pneumonia: A systematic review and meta-analysis

Abstract

Objective: This systematic review and meta-analysis aimed to evaluate the association between sarcopenia and mortality in adult patients with pneumonia. Methodology: PubMed, Embase, Scopus, and Web of Science were searched from inception to 14 October 2025. Observational studies comparing outcomes between pneumonia patients with and without sarcopenia were included, excluding COVID-19–related studies. Data were pooled using a random-effects model. Subgroup analyses were performed. Results: Eleven studies (12 datasets) were included. Sarcopenia, defined using CT-based low skeletal muscle mass measures, was significantly associated with increased mortality in pneumonia (OR: 1.03 95% CI 1.02–1.05, p = 0.00001). Between-study variability was substantial: I² = 87.6%. Sensitivity analyses confirmed the stability of the results. Subgroup analyses demonstrated significant associations across most locations, study designs, and follow-up periods, although not all subgroups reached statistical significance. Conclusions: Sarcopenia seems to be independently associated with increased mortality in patients with pneumonia. Further prospective studies using standardised sarcopenia definitions are necessary for better evidence.