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Yuzefpolskaya M, Bohn B, Ladanyi A, Pinsino A, Braghieri L, Carey MR, Clerkin K, Sayer GT, Latif F, Koji T, Uriel N, Nandakumar R, Uhlemann AC, Colombo PC, Demmer RT. Alterations in the sarcopenia index are associated with inflammation, gut, and oral microbiota among heart failure, left ventricular assist device, and heart transplant patients. J Heart Lung Transplant 2024; 43:1395-1408. [PMID: 38744352 DOI: 10.1016/j.healun.2024.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Sarcopenia, characterized by loss of muscle mass and function, is prevalent in heart failure (HF) and predicts poor outcomes. We investigated alterations in sarcopenia index (SI), a surrogate for skeletal muscle mass, in HF, left ventricular assist device (LVAD), and heart transplant (HT), and assessed its relationship with inflammation and digestive tract (gut and oral) microbiota. METHODS We enrolled 460 HF, LVAD, and HT patients. Repeated measures pre/post-procedures were obtained prospectively in a subset of LVAD and HT patients. SI (serum creatinine/cystatin C) and inflammatory biomarkers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha) were measured in 271 and 622 blood samples, respectively. Gut and saliva microbiota were assessed via 16S ribosomal ribonucleic acid sequencing among 335 stool and 341 saliva samples. Multivariable regression assessed the relationship between SI and (1) New York Heart Association class; (2) pre- versus post-LVAD or HT; and (3) biomarkers of inflammation and microbial diversity. RESULTS Median (interquartile range) natural logarithm (ln)-SI was -0.13 (-0.32, 0.05). Ln-SI decreased across worsening HF class, further declined at 1 month after LVAD and HT, and rebounded over time. Ln-SI was correlated with inflammation (r = -0.28, p < 0.01), gut (r = 0.28, p < 0.01), and oral microbial diversity (r = 0.24, p < 0.01). These associations remained significant after multivariable adjustment in the combined cohort but not for all individual cohorts. The presence of the gut taxa Roseburia inulinivorans was associated with increased SI. CONCLUSIONS SI levels decreased in symptomatic HF and remained decreased long-term after LVAD and HT. In the combined cohort, SI levels covaried with inflammation in a similar fashion and were significantly related to overall microbial (gut and oral) diversity, including specific taxa compositional changes.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York.
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Annamaria Ladanyi
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Alberto Pinsino
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Lorenzo Braghieri
- Division of Cardiovascular Medicine, Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Matthew R Carey
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Kevin Clerkin
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Gabriel T Sayer
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Farhana Latif
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Takeda Koji
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Nir Uriel
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Paolo C Colombo
- Division of Cardiovascular Medicine, Department of Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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Ota H, Fujimura T, Kunikata A, Yamagata T, Nozawa H, Ebishima H, Matsui H. Clinical significance and normal reference value of serum creatinine to cystatin C ratio in children. Clin Nutr ESPEN 2024; 62:278-284. [PMID: 38870020 DOI: 10.1016/j.clnesp.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND & AIMS Sarcopenia is a serious problem in adults and children. However, limited modalities are available for diagnosing pediatric sarcopenia. The serum creatinine to cystatin C ratio (Cre/CysC ratio) is a promising method for muscle quantification, although its clinical significance in the pediatric population is unknown. This study aimed to evaluate the relationship between the Cre/CysC ratio and physical performance. METHODS This was a single-center retrospective study. Patients aged <15 years who had visited the University of Tokyo Hospital for measurements of serum creatinine and cystatin C levels, body height, and body weight were included. The patients were assigned according to their age (<2 or ≥2 years), and the relationship between the Cre/CysC ratio and physical performance at the time of measurement was analyzed. RESULTS We included 266 patients, revealing a significant relationship between Cre/CysC ratio and physical performance in children aged ≥2 years (p < 0.001) but not in children aged <2 years (p = 0.42). The repeater-operator curve analysis of Cre/CysC to predict bedridden status showed good performance (the area under the curve was 0.82 (95% CI, 0.75-0.89)) and the cut-off value 0.44 had good accuracy (sensitivity 0.87, specificity 0.61). CONCLUSIONS The Cre/CysC ratio was a significant marker of impaired physical performance, and a Cre/CysC ratio <0.44 accurately predicted bedridden status in children aged >2 years.
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Affiliation(s)
- Hidehito Ota
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan.
| | - Tomomi Fujimura
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
| | - Ayumi Kunikata
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
| | - Tomosato Yamagata
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
| | - Hisataka Nozawa
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
| | - Hironori Ebishima
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
| | - Hikoro Matsui
- Department of Pediatrics, School of Medicine, The University of Tokyo, Adress: 7-3-1, Hongo, Bunkyo, Tokyo, Japan
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Khalil M, Di Ciaula A, Jaber N, Grandolfo R, Fiermonte F, Portincasa P. Multidimensional Assessment of Sarcopenia and Sarcopenic Obesity in Geriatric Patients: Creatinine/Cystatin C Ratio Performs Better than Sarcopenia Index. Metabolites 2024; 14:306. [PMID: 38921440 PMCID: PMC11205317 DOI: 10.3390/metabo14060306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI) are novel indicators for sarcopenia, but their accuracy may depend on various confounders. To assess CCR and SI diagnostic accuracy, we studied the clinical and biophysical parameters associated with sarcopenia or sarcopenic obesity. A total of 79 elderly patients (65-99 yrs, 33 females) underwent clinical, anthropometric, body composition, geriatric performance, and blood chemistry evaluation. The CCR and SI accuracy were assessed to identify sarcopenia. Sarcopenia was confirmed in 40.5%, and sarcopenic obesity in 8.9% of the subjects. Sarcopenic patients showed an increased Charlson comorbidity index, cardiovascular disease (CVD) rates and frailty, and decreased physical performance than non-sarcopenic subjects. Patients with sarcopenic obesity had increased body fat and inflammatory markers compared to obese subjects without sarcopenia. Sarcopenia was associated with a decreased CCR and SI. However, when the logistic regression models were adjusted for possible confounders (i.e., age, gender, Charlson comorbidity index, presence of CVD, and frailty score), a significant OR was confirmed for the CCR (OR 0.021, 95% CI 0.00055-0.83) but not for the SI. The AUC for the CCR for sarcopenia discrimination was 0.72. A higher performance was observed in patients without chronic kidney diseases (CKD, AUC 0.83). CCR, more than the SI, is a useful, non-invasive, and cost-effective tool to predict sarcopenia, irrespective of the potential confounders, particularly in subjects without CKD.
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Affiliation(s)
| | | | | | | | | | - Piero Portincasa
- Clinica Medica “A. Murri”, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.K.); (A.D.C.); (N.J.); (R.G.); (F.F.)
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da Silva SP, da Silva JDF, da Costa CBL, da Silva PM, de Freitas AFS, da Silva CES, da Silva AR, de Oliveira AM, Sá RA, Peixoto AR, de Oliveira APS, Paiva PMG, Napoleão TH. Purification, Characterization, and Assessment of Antimicrobial Activity and Toxicity of Portulaca elatior Leaf Lectin (PeLL). Probiotics Antimicrob Proteins 2023; 15:287-299. [PMID: 34420188 DOI: 10.1007/s12602-021-09837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Lectins are carbohydrate-binding proteins with several bioactivities, including antimicrobial properties. Portulaca elatior is a species found at Brazilian Caatinga and data on the biochemical composition of this plant are scarce. The present work describes the purification of P. elatior leaf lectin (PeLL) as well as the assessment of its antimicrobial activity and toxicity. PeLL, isolated by chromatography on a chitin column, had native liquid charge and subunit composition evaluated by electrophoresis. Hemagglutinating activity (HA) of PeLL was determined in the presence of carbohydrates or divalent cations, as well as after heating and incubation at different pH values. Changes in the lectin conformation were monitored by evaluating intrinsic tryptophan fluorescence and using the extrinsic probe bis-ANS. Antimicrobial activity was evaluated against Pectobacterium strains and Candida species. The minimal inhibitory (MIC), bactericidal (MBC), and fungicidal (MFC) concentrations were determined. Finally, PeLL was evaluated for in vitro hemolytic activity in human erythrocytes and in vivo acute toxicity in mice (5 and 10 mg/kg b.w. per os). PeLL (pI 5.4; 20 kDa) had its HA was inhibited by mannose, galactose, Ca2+, Mg2+, and Mn2+. PeLL HA was resistant to heating at 100 °C, although conformational changes were detected. PeLL was more active in the acidic pH range, in which no conformational changes were observed. The lectin presented MIC and MBC of 0.185 and 0.74 μg/mL for all Pectobacterium strains, respectively; MIC of 1.48 μg/mL for C. albicans, C. tropicalis, and C. krusei; MIC and MFC of 0.74 and 2.96 μg/mL for C. parapsilosis. No hemolytic activity or signs of acute toxicity were observed in the mice. In conclusion, a new, low-toxic, and thermostable lectin was isolated from P. elatior leaves, being the first plant compound to show antibacterial activity against Pectobacterium.
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Affiliation(s)
- Suéllen Pedrosa da Silva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Pollyanna Michelle da Silva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Abdênego Rodrigues da Silva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Alisson Macário de Oliveira
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Roberto Araújo Sá
- Centro Acadêmico Do Agreste, Universidade Federal de Pernambuco, Caruaru, Pernambuco, Brazil
| | - Ana Rosa Peixoto
- Departamento de Tecnologia E Ciências Sociais, Universidade Do Estado da Bahia, Juazeiro, Bahia, Brazil
| | | | - Patrícia Maria Guedes Paiva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Thiago Henrique Napoleão
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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Zhang JZ, Shi W, Zou M, Zeng QS, Feng Y, Luo ZY, Gan HT. Diagnosis, prevalence, and outcomes of sarcopenia in kidney transplantation recipients: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:17-29. [PMID: 36403578 PMCID: PMC9891953 DOI: 10.1002/jcsm.13130] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I2 . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8 years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I2 = 93.45%], including 22% (95% CI: 14-32%, I2 = 88.76%) in men and 27% (95% CI: 14-41%, I2 = 90.56%) in women (P = 0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I2 = 95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I2 = 90.37%) (P = 0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I2 = 61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I2 = 0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I2 = 10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I2 = 84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I2 = 12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I2 = 87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I2 = 0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I2 = 0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.
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Affiliation(s)
- Jin-Zhi Zhang
- Department of Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Shi
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Zou
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi-Shan Zeng
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Feng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Yi Luo
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua-Tian Gan
- Lab of Inflammatory Bowel Disease, The Center for Inflammatory Bowel Disease, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Zheng WH, Zhu YB, Yao Y, Huang HB. Serum creatinine/cystatin C ratio as a muscle mass evaluating tool and prognostic indicator for hospitalized patients: A meta-analysis. Front Med (Lausanne) 2023; 9:1058464. [PMID: 36698829 PMCID: PMC9868859 DOI: 10.3389/fmed.2022.1058464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Sarcopenia is a syndrome of decreased muscle mass and deficits in muscle strength and physical function. We aimed to investigate the relationship between creatinine/cystatin C ratio (CCR) and sarcopenia and the prognostic value of CCR in hospitalized patients. Materials and methods We searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to August 25, 2022. Meta-analyses were performed to evaluate the relationship between CCR and skeletal muscle [computed tomography-assessed skeletal muscle (CTASM), muscle strength, and physical performance], prognosis and important clinical outcomes in hospitalized adults. The pooled correlation coefficient, the area under the receiver operating characteristic (ROC) curves, and hazard ratio (HR) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity. Results A total of 38 studies with 20,362 patients were eligible. These studies were of moderate to high quality. Our results showed that CCR was significant correlations with all CTASM types (Fisher's Z ranged from 0.35 to 0.5; P values ranged from < 0.01 to 0.01), handgrip strength (Fisher's Z = 0.39; 95% CI, 0.32-0.45; P < 0.001) and gait speed (Fisher's Z = 0.25; 95% CI, 0.21-0.30; P < 0.001). The ROC curves suggested that CCR had good diagnostic efficacy (0.689; 95% CI, 0.632-0.746; P < 0.01) for sarcopenia. CCR can reliably predict mortality in hospitalized patients, which was confirmed by regression analysis of CCR as both continuous (HR 0.78; 95% CI, 0.72-0.84; P < 0.01) and categorical variables (HR 2.05; 95% CI, 1.58-2.66; P < 0.0001). In addition, less evidence showed that higher CCR was independently associated with a shorter duration of mechanical ventilation, reduced length of stay in the intensive care unit and hospital, less nutritional risk, and decreased complications in hospitalized patients. Conclusion CCR could be a simple, economical, and effective screening tool for sarcopenia in hospitalized patients, and it is a helpful prognostic factor for mortality and other important clinical outcomes. Systematic review registration https://inplasy.com/inplasy-2022-9-0097/, identifier INPLASY202290097.
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Affiliation(s)
- Wen-He Zheng
- Department of Critical Care Medicine, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yi-Bing Zhu
- Department of Critical Care Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Yao
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hui-Bin Huang
- Department of Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,*Correspondence: Hui-Bin Huang,
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Kusunoki H, Ekawa K, Kato N, Yamasaki K, Motone M, Shinmura K, Yoshihara F, Shimizu H. Association between oral frailty and cystatin C-related indices-A questionnaire (OFI-8) study in general internal medicine practice. PLoS One 2023; 18:e0283803. [PMID: 37093792 PMCID: PMC10124892 DOI: 10.1371/journal.pone.0283803] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Cystatin C-related indices such as the ratio of creatinine to cystatin C (Cr/CysC) and the ratio of estimated glomerular filtration rate by cystatin C (eGFRcys) to creatinine eGFRcre (eGFRcys/eGFRcre) levels have been shown to be associated with muscle mass and strength and can be markers of sarcopenia. Oral frailty is defined as an age-related gradual loss of oral functions, accompanied by a decline in cognitive and physical functions. It results in adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, poor quality of life, and increased hospitalization and falls. Therefore, poor oral health among the elderly is an important health concern due to its association with the pathogenesis of systemic frailty, suggesting it to be a multidimensional geriatric syndrome. The Oral Frailty Index-8 (OFI-8) is a questionnaire that can be used for easy screening of oral frailty. This study aimed to investigate whether cystatin C- related indices are different between patients with low to moderate risk of oral frailty and those at high risk of oral frailty, using the OFI-8 in attending a general internal medicine outpatient clinic. MATERIALS AND METHODS This is a cross-sectional study that included 251 patients with a mean age of 77.7±6.6 years and a median age of 77 years (128 men: mean age, 77.1±7.3 years; median age, 77 years and 123 women: mean age, 78.4±5.7 years; median age, 78 years) attending general internal medicine outpatient clinics. OFI-8 scores were tabulated by gender to determine whether there were differences between patients at low to moderate risk of oral frailty (OFI-8 score ≤3 points) and those at high risk (OFI-8 score ≥4 points) in Cr/CysC, eGFRcys/eGFRcre levels, height, weight, grip strength, etc. were examined. RESULTS The OFI-8 score was higher in women than in men, suggesting that oral frailty is more common in women. Cr/CysC, eGFRcys/eGFRcre and grip strength were significantly lower in both men and women in the high-risk group for oral frailty (OFI-8 score ≥ 4). Height, hemoglobin level, red blood cell count, and serum albumin levels were significantly lower in men with an OFI-8 score ≥4. Receiver operating characteristic curve (ROC) analysis also showed that Cr/CysC and eGFRcys/eGFRcre were significantly associated with an OFI-8 score≥4 in both men and women. CONCLUSION Cr/CysC and eGFRcys/eGFRcre were significantly lower in the high-risk group for oral frailty on the OFI-8in both men and women. A relationship exists among cystatin C-related indices, which can effectively screen systemic frailty. Similarly, the OFI-8 score can be used to effectively screen oral frailty. Thus, a collaboration that incorporates both systemic and oral frailty from medical and dental perspectives is required.
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Affiliation(s)
- Hiroshi Kusunoki
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
- Department of General Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazumi Ekawa
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
- Department of Environmental and Preventive Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Nozomi Kato
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
| | - Keita Yamasaki
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
- Department of Health and Sports Sciences Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masaharu Motone
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
- Faculty of Health Sciences, Osaka Dental University, Hirakata, Osaka, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Fumiki Yoshihara
- Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hideo Shimizu
- Department of Internal Medicine, Osaka Dental University, Hirakata, Osaka, Japan
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Kitago M, Seino S, Shinkai S, Nofuji Y, Yokoyama Y, Toshiki H, Abe T, Taniguchi Y, Amano H, Murayama H, Kitamura A, Akishita M, Fujiwara Y. Cross-Sectional and Longitudinal Associations of Creatinine-to-Cystatin C Ratio with Sarcopenia Parameters in Older Adults. J Nutr Health Aging 2023; 27:946-952. [PMID: 37997714 DOI: 10.1007/s12603-023-2029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Accumulating evidence from cross-sectional studies suggests that the serum creatinine-to-cystatin C ratio (CCR) may be a useful biomarker for sarcopenia. This study aimed to assess the cross-sectional and longitudinal associations of CCR with sarcopenia and its parameters in community-dwelling older adults. DESIGN Cross-sectional and longitudinal study. SETTING AND PARTICIPANTS This 6-year prospective cohort study included the repeated measurement data from 1,253 Japanese residents (662 males and 591 females) aged ≥65 years who underwent medical checkups in Kusatsu and Hatoyama, Japan. A total of 4,421 observations were collected. MEASUREMENTS The CCR was grouped into quartiles by sex (Q1-Q4) using Q4 as the reference category. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 algorithm. Skeletal muscle mass index (SMI) measured using segmental multifrequency bioelectrical impedance analysis, handgrip strength (HGS), usual gait speed (UGS), and maximal gait speed (MGS) were measured repeatedly as sarcopenia parameters. The association of the CCR with changes in sarcopenia, SMI, HGS, UGS, and MGS during the 6-year period were analyzed using a generalized linear mixed-effects model. RESULTS The prevalence of sarcopenia at baseline was 13.1% (11.9% in males and 14.5% in females). In a cross-sectional analysis, the CCR quartile was inversely associated with sarcopenia and was positively associated with SMI, HGS, and MGS (P for trend < 0.001). In a longitudinal analysis during the 6 years, a significant increase in sarcopenia in Q2 (B = 1.1% point/year; P = 0.026 for group-by-time interaction) and significant declines in SMI (B = -0.01 kg/m2/year; P = 0.044 for group-by-time interaction) and MGS (B = -0.008 m/sec/year; P = 0.041 for group-by-time interaction) in Q1 were observed compared with Q4. However, the dose-response relationship was significant only for MGS (P = 0.033 for trend). No significant group-by-time interaction was observed for HGS. CCR was not significantly associated with UGS either cross-sectionally or longitudinally. CONCLUSIONS CCR is a useful biomarker regarding the status of sarcopenia. It may be used for sarcopenia screening even in older adults whose physical function is difficult to assess. However, further longitudinal studies are needed to determine whether CCR can be a predictor of future sarcopenia.
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Affiliation(s)
- M Kitago
- Yoshinori Fujiwara, MD, PhD, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan, Phone: +81-3-3964-3241, E-mail:
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9
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van Vliet IMY, Post A, Kremer D, Boslooper-Meulenbelt K, van der Veen Y, de Jong MFC, Pol RA, Jager-Wittenaar H, Navis GJ, Bakker SJL, Gan C, Sanders J, Verschuuren E, Damman K, Lexmond W, Blokzijl J, de Borst M, Erasmus M, Porte R, de Boer M, Pol R, Berger S, Eisenga M, Neto AG, Kremer D, van Londen M, Jong JA, Siebelink M, van Pelt L, Niesters H, Bodewes F, Hepkema B, Ranchor A, Douwes R, Jager‐Wittenaar H, Navis GJ, Bakker SJ. Muscle mass, muscle strength and mortality in kidney transplant recipients: results of the TransplantLines Biobank and Cohort Study. J Cachexia Sarcopenia Muscle 2022; 13:2932-2943. [PMID: 36891995 PMCID: PMC9745460 DOI: 10.1002/jcsm.13070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/10/2022] [Accepted: 07/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR. METHODS Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height2 (CERI). Muscle strength was determined by hand grip strength indexed for height2 (HGSI). Secondary analyses were performed using parameters not indexed for height2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Boslooper-Meulenbelt
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne van der Veen
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C.T. Gan
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.S.F. Sanders
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - E.A.M. Verschuuren
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - K. Damman
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - W.S. Lexmond
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J. Blokzijl
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.H. de Borst
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.E. Erasmus
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.J. Porte
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.T. de Boer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.A. Pol
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - S.P. Berger
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.F. Eisenga
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.W. Gomes Neto
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - D. Kremer
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M. van Londen
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - J.H. Annema‐de Jong
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - M.J. Siebelink
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - L.J. van Pelt
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - H.G.M. Niesters
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - F.A.J.A. Bodewes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - B.G. Hepkema
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - A.V. Ranchor
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - R.M. Douwes
- Groningen Transplant Center University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Harriët Jager‐Wittenaar
- Department of Oral and Maxillofacial Surgery University of Groningen, University Medical Center Groningen Groningen The Netherlands
- Research Group Healthy Ageing, Health Care and Nursing Hanze University of Applied Sciences Groningen The Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology University of Groningen, University Medical Center Groningen Groningen The Netherlands
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10
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Mauro E, Diaz JM, Garcia-Olveira L, Spina JC, Savluk L, Zalazar F, Saidman J, De Santibañes M, Pekolj J, De Santibañes E, Crespo G, Abraldes JG, Gadano A. Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list. Hepatol Commun 2022; 6:1699-1710. [PMID: 35238487 PMCID: PMC9234615 DOI: 10.1002/hep4.1919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio [OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR: 1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007). The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.
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Affiliation(s)
- Ezequiel Mauro
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Juan Manuel Diaz
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Juan Carlos Spina
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Lorena Savluk
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Fernanda Zalazar
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Julia Saidman
- Radiology DepartmentHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Martin De Santibañes
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Juan Pekolj
- HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Gonzalo Crespo
- Liver Transplant UnitLiver UnitIDIBAPSCIBERehdHospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Juan G Abraldes
- Division of GastroenterologyUniversity of AlbertaCEGIIREdmontonAlbertaCanada
| | - Adrían Gadano
- Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.,HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina
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11
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Pinsino A, Fabbri M, Braghieri L, Bohn B, Gaudig AJ, Kim A, Takeda K, Naka Y, Sayer GT, Uriel N, Demmer RT, Faillace RT, Husain SA, Mohan S, Colombo PC, Yuzefpolskaya M. The difference between cystatin C- and creatinine-based assessment of kidney function in acute heart failure. ESC Heart Fail 2022; 9:3139-3148. [PMID: 35762103 DOI: 10.1002/ehf2.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/03/2022] [Accepted: 05/08/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Acute heart failure (HF) is associated with muscle mass loss, potentially leading to overestimation of kidney function using serum creatinine-based estimated glomerular filtration rate (eGFRsCr ). Cystatin C-based eGFR (eGFRCysC ) is less muscle mass dependent. Changes in the difference between eGFRCysC and eGFRsCr may reflect muscle mass loss. We investigated the difference between eGFRCysC and eGFRsCr and its association with clinical outcomes in acute HF patients. METHODS AND RESULTS A post hoc analysis was performed in 841 patients enrolled in three trials: Diuretic Optimization Strategy Evaluation (DOSE), Renal Optimization Strategies Evaluation (ROSE), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF). Intra-individual differences between eGFRs (eGFRdiff ) were calculated as eGFRCysC -eGFRsCr at serial time points during HF admission. We investigated associations of (i) change in eGFRdiff between baseline and day 3 or 4 with readmission-free survival up to day 60; (ii) index hospitalization length of stay (LOS) and readmission with eGFRdiff at day 60. eGFRCysC reclassified 40% of samples to more advanced kidney dysfunction. Median eGFRdiff was -4 [-11 to 1.5] mL/min/1.73 m2 at baseline, became more negative during admission and remained significantly different at day 60. The change in eGFRdiff between baseline and day 3 or 4 was associated with readmission-free survival (adjusted hazard ratio per standard deviation decrease in eGFRdiff : 1.14, P = 0.035). Longer index hospitalization LOS and readmission were associated with more negative eGFRdiff at day 60 (both P ≤ 0.026 in adjusted models). CONCLUSIONS In acute HF, a marked difference between eGFRCysC and eGFRsCr is present at baseline, becomes more pronounced during hospitalization, and is sustained at 60 day follow-up. The change in eGFRdiff during HF admission and eGFRdiff at day 60 are associated with clinical outcomes.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.,Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matteo Fabbri
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lorenzo Braghieri
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Andrea Kim
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Syed A Husain
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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12
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An JN, Kim JK, Lee HS, Kim SG, Kim HJ, Song YR. Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease. Kidney Res Clin Pract 2022; 41:580-590. [PMID: 35791742 PMCID: PMC9576455 DOI: 10.23876/j.krcp.21.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jwa-Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung-Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung Jik Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
- Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Republic of Korea
- Correspondence: Young Rim Song Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Republic of Korea. E-mail:
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13
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Tang T, Xie L, Hu S, Tan L, Lei X, Luo X, Yang L, Yang M. Serum creatinine and cystatin C-based diagnostic indices for sarcopenia in advanced non-small cell lung cancer. J Cachexia Sarcopenia Muscle 2022; 13:1800-1810. [PMID: 35297568 PMCID: PMC9178169 DOI: 10.1002/jcsm.12977] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/06/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sarcopenia is an important prognostic factor of lung cancer. The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI, serum creatinine × cystatin C-based glomerular filtration rate) are novel screening tools for sarcopenia; however, the diagnostic accuracy of the CCR and SI for detecting sarcopenia remains unknown. We aimed to explore and validate the diagnostic values of the CCR and SI for determining sarcopenia in non-small cell lung cancer (NSCLC) and to explore their prognostic values for overall survival. METHODS We conducted a prospective cohort study of adult patients with stage IIIB or IV NSCLC. Levels of serum creatinine and cystatin C were measured to calculate the CCR and SI. Sarcopenia was defined separately using CCR, SI, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Participants were randomly sampled into derivation and validation sets (6:4 ratio). The cutoff values for diagnosing sarcopenia were determined based on the derivation set. Diagnostic accuracy was analysed in the validation set through receiver operating characteristic (ROC) curves. Cox regression models and survival curves were applied to evaluate the impact of different sarcopenia definitions on survival. RESULTS We included 579 participants (women, 35.4%; mean age, 58.4 ± 8.9 years); AWGS-defined sarcopenia was found in 19.5% of men and 10.7% of women. Both CCR and SI positively correlated with computed tomography-derived and bioimpedance-derived muscle mass and handgrip strength. The optimal cutoff values for CCR and SI were 0.623 and 54.335 in men and 0.600 and 51.742 in women, with areas under the ROC curves of 0.837 [95% confidence interval (CI): 0.770-0.904] and 0.833 (95% CI: 0.765-0.901) in men (P = 0.25), and 0.808 (95% CI: 0.682-0.935) and 0.796 (95% CI: 0.668-0.924) in women (P = 0.11), respectively. The CCR achieved sensitivities and specificities of 73.0% and 93.7% in men and 85.7% and 65.7% in women, respectively; the SI achieved sensitivities and specificities of 75.7% and 86.5% in men and 92.9% and 62.9% in women, respectively. CCR-defined, SI-defined, and AWGS-defined sarcopenia were independently associated with a high mortality risk [hazard ratio (HR) = 1.75, 95% CI: 1.25-2.44; HR = 1.55, 95% CI: 1.11-2.17; and HR = 1.76, 95% CI: 1.22-2.53, respectively]. CONCLUSIONS CCR and SI have satisfactory and comparable diagnostic accuracy and prognostic values for sarcopenia in patients with advanced NSCLC. Both may serve as surrogate biomarkers for evaluating sarcopenia in these patients. However, further external validations are required.
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Affiliation(s)
- Tianjiao Tang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatric Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingling Xie
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Song Hu
- Department of Radiology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Lingling Tan
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaozhen Lei
- Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Xiaozhen Luo
- Department of Oncology, Shangjin Nanfu Hospital, Sichuan University, Chengdu, China
| | - Ling Yang
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- National Clinical Research Center for Geriatric Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
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14
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de Amorim GJ, Calado CKM, Souza de Oliveira BC, Araujo RPO, Filgueira TO, de Sousa Fernandes MS, Castoldi A, Vajgel G, Valente LM, de Lima-Filho JL, Carvalho PRC, Souto FO. Sarcopenia in Non-Dialysis Chronic Kidney Disease Patients: Prevalence and Associated Factors. Front Med (Lausanne) 2022; 9:854410. [PMID: 35463026 PMCID: PMC9021613 DOI: 10.3389/fmed.2022.854410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background Sarcopenia is related to morbidity and mortality in non-dialysis Chronic Kidney Disease (ND-CKD) patients; however, the pathophysiology of sarcopenia remains unclear. The study aimed to assess the prevalence and factors associated with sarcopenia in ND-CKD individuals. Methods We cross-sectionally evaluated 139 prevalent ND-CKD patients attending our outpatient clinic at Hospital das Clínicas of the Federal University of Pernambuco, between April and October 2019. Patients older than 18 years old and at G3-G5 CKD stages were included. Hand grip strength, Muscle Mass appendicular Index, and Gait Speed (GS) were defined by the standards of the European Working Group on Sarcopenia in Older People 2 guideline. Results Sarcopenia prevalence was 20.9% and severe sarcopenia 2.9%. Sarcopenic were mostly found in elderly ones (64.8 ± 13.5 years vs. 54.9 ± 12.8 years, p < 0.001), revealing lower body mass index [26.1 (6.8) vs. 28.6 (6.2), p = 0.023], lower phase angle (PhA) [4.50 (1.10) vs. 5.60 (1.20), p < 0.001] and lower GS [1.00 (0.50) vs. 1.40 (0.4), p < 0.001]. They also presented lower serum creatinine levels [2.40 (1.50) vs. 3.0 (1.8), p = 0.032], lower Albumin-to-Creatinine Ratio [72.60 (1008.30) vs. 342.30 (1172.1), p = 0.039] and Hemoglobin levels [11.45 (1.8) vs. 12.60 (2.40), p = 0.003], and higher levels of C-reactive protein [0.2 (0.80) vs. 0.03 (0.3), p = 0.045] compared to non-sarcopenic. Under Poisson Multivariate Model, PhA [Relative precision (RP): 0.364, Confidence Interval (CI) (95%):0.259–0.511, p < 0.001], Interleukin six (IL-6) [RP: 1.006, CI (95%):1.001–1.01, p = 0.02] and serum creatinine levels [RP: 0.788, CI (95%): 0.641–0.969, p = 0.024] were associated with sarcopenia. Conclusions Sarcopenia predominance was identified in our ND-CKD population, and was associated with lower PhA values, higher IL-6 levels, and lower serum creatinine levels.
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Affiliation(s)
- Geraldo José de Amorim
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil.,Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | | | | | - Tayrine Ordonio Filgueira
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | - Angela Castoldi
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | - Gisele Vajgel
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Lucila Maria Valente
- Nephrology Service, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - José Luiz de Lima-Filho
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
| | | | - Fabricio Oliveira Souto
- Laboratory of Immunopathology Keizo Asami (LIKA/Federal University of Pernambuco (UFPE)), Recife, Brazil
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15
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Okubo N, Yoshida T, Tanaka K, Okada N, Hosoi K, Ohara M, Takahashi K. Serum creatinine to cystatin C ratio reflects preoperative and early postoperative walking ability in older patients with hip fracture. J Cachexia Sarcopenia Muscle 2022; 13:945-954. [PMID: 35170256 PMCID: PMC8977951 DOI: 10.1002/jcsm.12940] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/09/2022] [Accepted: 01/17/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The sarcopenia index (SI), calculated as the ratio of serum creatinine to cystatin C levels, reflects skeletal muscle mass and strength. Patients with hip fracture (HF) and sarcopenia have poor functional outcomes, and many require long-term care after surgery. We hypothesized that the SI can predict preoperative and early postoperative functional outcomes. METHODS Preoperative serum creatinine and cystatin C were measured to calculate the SI for patients with surgically treated HF (n = 130, mean age: 87.8 ± 6.9 years). Walking ability before and 2 weeks after surgery was assessed, and patients were dichotomized into independent and assistance groups. To assess the validity of the SI, we examined its correlation with the quality [computed tomography (CT) value] and quantity (cross-sectional area) of the muscles around the hip on the non-operated side, which were preoperatively measured using CT. Receiver operating characteristic (ROC) analysis was performed to evaluate the prognostic value of the SI. RESULTS The SI of the preoperative independent (n = 77) and assistance groups (n = 53) significantly differed (70.2 ± 12.4 and 60.1 ± 9.8, respectively, P < 0.000001). At 2 weeks after surgery, the SI was significantly higher in the independent group (n = 31, 73.0 ± 14.9) than in the assistance group (n = 99, 64.0 ± 10.7, P = 0.0003). In the preoperative independent group, 28 could walk independently after surgery (SI: 74.8 ± 14.0) while 49 required assistance (SI: 67.7 ± 10.6, P = 0.01). For patients with femoral neck fracture (FNF), the SIs were significantly higher in the postoperative independent group (78.6 ± 15.7) than in the postoperative assistance group (63.2 ± 10.9, P = 0.002). Logistic regression analysis showed that the odds ratio (95% confidence interval) of the SI for postoperative walking ability was 0.95 (0.91-0.99, P = 0.03). The correlations of SIs with CT values and cross-sectional areas were as follows: iliopsoas at the apex of the femoral head, r = 0.40, P < 0.001 and r = 0.49, P < 0.001, respectively; rectus femoris at the level of the lessor trochanter, r = 0.26, P = 0.007 and r = 0.37, P < 0.001, respectively. ROC analysis for predicting postoperative walking ability in preoperative independent patients with HF and FNF revealed areas under the curve (95% confidence interval) of 0.63 (0.50-0.76) and 0.80 (0.65-0.96), respectively. CONCLUSIONS In patients with HF, the SI correlated with preoperative walking ability and could predict postoperative walking ability. Among patients who could walk independently before surgery, those with high SIs could walk independently early in the postoperative period. The SI is beneficial for estimating walking ability in patients with HF.
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Affiliation(s)
- Naoki Okubo
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Yoshida
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Tanaka
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoya Okada
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kunihiko Hosoi
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masato Ohara
- Department of Orthopedic Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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16
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Huang D, Xie C, Sun C, Chen M, Li L, Yi H, Liao J, Zhao X, Shen X, He D, Li D, Wu D. Serum Creatinine to Cystatin C Ratio is an Effective Indicator for Muscle Strength Decline in Men with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:781-789. [PMID: 35422619 PMCID: PMC9004674 DOI: 10.2147/copd.s356314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose This study explored the value of the serum creatinine/cystatin C (Cr/CysC) ratio in diagnosing the reduction of muscle strength in men with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Patients and Methods In this study, we enrolled 72 male patients with AECOPD and 32 male patients with stable chronic obstructive pulmonary disease (COPD). We compared clinical characteristics between the AECOPD and stable COPD groups. Then, we subdivided AECOPD patients into normal muscle strength and low muscle strength groups; we compared the clinical characteristics between these two groups. We analyzed the relationships of serum creatinine (Cr), cystatin C (CysC), and Cr/CysC ratio with clinical characteristics in male AECOPD patients. We also investigated whether the Cr/CysC ratio could aid in the diagnosis of muscle strength decline via receiver operating characteristic curve and binary logistic regression analysis. Results We found that handgrip strength, Cr/CysC ratio, serum Cr, FEV1, FVC, and FEV1%pred were lower in AECOPD patients than in stable COPD patients. Among AECOPD patients, BMI, weight, FEV1, FVC, FEV1%pred, and Cr/CysC ratio were lower in the low muscle strength group than in the normal muscle strength group; there were more patients with ≥2 acute exacerbations within the past year in the low muscle strength group. The Cr/CysC ratio was correlated with handgrip strength, FEV1, FVC, FEV1%pred, BMI and weight. The area under curve for low handgrip strength was greater for the Cr/CysC ratio than for Cr. Binary logistic regression analysis showed that a Cr/CysC ratio <0.99 was a risk factor for decreased muscle strength in male patients with AECOPD. Conclusion The Cr/CysC ratio is a useful predictor of muscle strength decline in male AECOPD patients, while a low Cr/CysC ratio is a risk factor for muscle strength decline in male patients with AECOPD.
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Affiliation(s)
- Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Canhui Xie
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Chaoqun Sun
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Min Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Lian Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Huajuan Yi
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Jinyu Liao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Xuanna Zhao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Xiaoping Shen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Donglan He
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Dongming Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People’s Republic of China
- Correspondence: Dong Wu; Dongming Li, Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, 57th South Renmin Road, Zhanjiang, 524001, Guangdong, People’s Republic of China,Tel/Fax +867592387413, Email ;
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17
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Zheng C, Wang E, Li JS, Xie K, Luo C, Ge QY, Hu LW, Shen Y. Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer. BMC Geriatr 2022; 22:207. [PMID: 35287579 PMCID: PMC8922862 DOI: 10.1186/s12877-022-02925-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background & aims Sarcopenia is associated with poor clinical outcomes of patients who underwent esophagectomy. The current diagnostic criteria for sarcopenia are complex and laborious. We aimed to employ the simple and economic indicator sarcopenia index (SI = creatinine/cystatin C ×100) to screen for sarcopenia and to evaluate its prognostic value in patients with esophageal cancer (EC). Methods Older participants in the National health and nutrition examination survey (NHANES) database (1999–2002) were divided into three groups according to tertiles of the SI value to explore the feasibility of SI in the diagnosis of sarcopenia. Restricted cubic spline (RCS) was utilized to show the non-linear relationship between all-cause mortality and SI. Patients with EC admitted to Jinling Hospital were enrolled to validate the efficacy and prognostic value of SI. Cut-off values of SI were determined using receiver operating characteristic curves. Multivariable logistic analyses and Cox analyses were used to identify the independent factors of postoperative complications and long-term survival, respectively. Results A total of 989 participants were identified from the NHANES database. SI showed the diagnostic value of sarcopenia (tertile 1 vs. tertile 3: odds ratio [OR]=3.67, 95% confidence interval [CI]: 1.52–8.87, p=0.004; tertile 2 vs. tertile 3: OR=1.79, 95% CI: 0.75–4.28, p=0.191) adjusted for race, gender, and body mass index (BMI). Individuals with SI ≤ 68 had a poorer overall survival (OS) (hazard ratio [HR]=2.14, 95% CI: 1.71–2.68, p<0.001), and the RCS plot showed that the all-cause mortality risk gradually decreased with the increase in SI. Then, 203 patients with EC were enrolled, of which 76 patients were diagnosed with sarcopenia. There was a linear correlation between SI and skeletal muscle index and prealbumin, indicating that SI was reliable for diagnosing sarcopenia. Patients in the high sarcopenia risk group (Male: SI < 62; Female: SI < 55) showed a higher incidence of complications (OR=3.50, 95% CI: 1.85–6.61, p<0.001) and poorer long-term survival (HR=2.62, 95% CI: 1.02–6.77, p=0.046). Conclusion SI could be used to identify sarcopenia in patients with EC, and it is a useful prognostic factor of postoperative complications and long-term survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02925-8.
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Affiliation(s)
- Chao Zheng
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | | | - Jiang-Shan Li
- University of Science and Technology Beijing, Beijing, China
| | - Kai Xie
- Department of Cardiothoracic Surgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Chao Luo
- Department of Cardiothoracic Surgery, Jinling Hospital, Southern Medical University, Guangzhou, China
| | - Qi-Yue Ge
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Li-Wen Hu
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China. .,Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.
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18
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Lin YL, Wang CH, Chang IC, Hsu BG. A Novel Application of Serum Creatinine and Cystatin C to Predict Sarcopenia in Advanced CKD. Front Nutr 2022; 9:828880. [PMID: 35284461 PMCID: PMC8914226 DOI: 10.3389/fnut.2022.828880] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
Sarcopenia is highly prevalent in patients with advanced chronic kidney disease (CKD), yet a reliable serum index has not been established. The product of serum creatinine and the estimated glomerular filtration rate based on cystatin C (Cr×eGFRcys) was recently proposed as a sarcopenia index (SI), approximately to 24-h filtered creatinine through the glomerulus. We aimed to evaluate the diagnostic validity of the novel SI in advanced CKD. In 297 patients with non-dialysis stage 3b-5 CKD, aged 68.8 ± 12.9 years, the total skeletal muscle mass (SMM), handgrip strength (HGS), and usual gait speed were assessed. Sarcopenia was defined based on the Asian Working Group for Sarcopenia 2019 consensus update. The prevalence of sarcopenia in this cohort was 20.2%. The SI correlated moderately with SMM (r = 0.503, P < 0.001), HGS (r = 0.508, P < 0.001), and gait speed (r = 0.381, P < 0.001); the independency of the SI with three muscle metrics was confirmed after extensive adjustment. For sarcopenia prediction, the SI had acceptable discriminative powers in males [area under the receiver operating characteristic curve (AUC) 0.646, 95% confidence interval (CI) 0.569–0.718] and females (AUC 0.754, 95% CI 0.670–0.826). In males, the best cut-off was 53.9, which provided 71.1% sensitivity, 58.0% specificity, 32.9% positive predictive value (PPV), and 87.4% negative predictive value (NPV); in females, the best cut-off was 45.8, which provided 81.8% sensitivity, 62.3% specificity, 31.0% PPV, and 94.3% NPV. In conclusion, Cr×eGFRcys could be served as a surrogate marker for sarcopenia and may be helpful for sarcopenia screening in advanced CKD. Further studies are needed to expand our investigation.
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Affiliation(s)
- Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Chen Chang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- *Correspondence: Bang-Gee Hsu
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19
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Potok OA, Ix JH, Shlipak MG, Bansal N, Katz R, Kritchevsky SB, Rifkin DE. Cystatin C and Creatinine-Based Glomerular Filtration Rate Estimation Differences and Muscle Quantity and Functional Status in Older Adults. Kidney Med 2022; 4:100416. [PMID: 35386603 PMCID: PMC8978136 DOI: 10.1016/j.xkme.2022.100416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Rationale & Objective The difference in the estimated glomerular filtration rate based on cystatin C and that based on creatinine (eGFRDiff) is known to be associated with frailty and mortality. Creatinine is influenced by muscle mass, more so than cystatin C; we aimed to determine whether eGFRDiff is associated with muscle quantity and to what extent muscle quantity explains the relationship between eGFRDiff and poor functional status. Study Design A cohort analysis of the health, aging, and body composition study (HABC). Setting & Participants Overall, 2,970 HABC participants had their baseline serum creatinine level, cystatin C level, and body composition measured using imaging. Exposure Estimated glomerular filtration rates (eGFRs) were calculated using Chronic Kidney Disease Epidemiology Collaboration equations (estimated glomerular filtration rate based on cystatin C [eGFRCys] and estimated glomerular filtration rate based on creatinine [eGFRCr]), and eGFRDiff was calculated as eGFRCys − eGFRCr. Outcomes The total thigh muscle area was evaluated using computed tomography. The health, aging, and body composition study physical performance battery was scored on a continuous scale (standing and walking tasks); poor functional status was characterized by the lowest quartile. Analytical Approach We used linear regression to model the cross-sectional association of eGFRDiff and muscle measures. We used logistic regression to evaluate the association of eGFRDiff with poor functional status. Results The mean age was 74 ± 3 years; the eGFRCys, eGFRCr, and eGFRDiff was 72 ± 18, 68 ± 15, and 4 ± 14 mL/min/1.73 m2, respectively. Compared with participants in the reference group (−10 < eGFRDiff ≤ 10 mL/min/1.73 m2), those in the negative eGFRDiff group (≤−10 mL/min/1.73 m2) were more likely to have comorbidities, a slower gait, and worse functional status. They had an approximately 14-cm2 smaller thigh muscle area in a fully adjusted model. Compared with the reference group, those in the negative group had 1.89-fold higher odds of poor functional status (unadjusted). This relationship was minimally attenuated after adjustment for thigh muscle, thigh fat area, appendicular lean mass, and limb fat mass, both individually and in combination. Limitations The functional status outcome was specific to HABC. The muscle measures did not capture dynamic turnover. Conclusions The difference of eGFRCys − eGFRCr provides information on older adults’ functional status, which is only partially explained by muscle quantity and quality.
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20
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Sim M, Dalla Via J, Scott D, Lim WH, Hodgson JM, Zhu K, Daly RM, Duque G, Prince RL, Lewis JR. Creatinine to cystatin C ratio, a biomarker of sarcopenia measures and falls risk in community-dwelling older women. J Gerontol A Biol Sci Med Sci 2021; 77:1389-1397. [PMID: 34907424 DOI: 10.1093/gerona/glab369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ratio of creatinine to cystatin C (Cr:Cyc) has been proposed as a biomarker of sarcopenia, as greater Cr:Cyc is typically associated with greater muscle mass. We examined the relationship between Cr:Cyc with individual sarcopenia measures, 5 y self-reported falls and 12 y fall-related hospitalizations in a prospective cohort study of 1,118 community-dwelling older women (mean age 75.2 ± 2.7 y). METHODS Serum Cr:Cyc, hand grip strength and timed-up-and-go (TUG) performance were assessed at baseline (1998), while dual-energy X-ray absorptiometry (DXA) derived ALM/Height (m) 2 was obtained in a subset of women at baseline and 1 year (n=334). Incident 5 y self-reported falls and 12-year falls-related hospitalizations were considered. RESULTS In a multivariable-adjusted model, women with the lowest Cr:Cyc (Quartile [Q] 1) had 5% (1.0 kg) weaker grip strength, as well as 3.7% (0.22 kg/m 2) and 5.5% (0.031) lower ALM adjusted for height 2 or BMI, respectively, compared to women in Q4 (all p<0.05). 329 women reported an incident fall over 5 years, and 326 fall-related hospitalizations were recorded over 12 years. Women in Q1 of Cr:Cyc had a greater relative hazard for a fall over 5 years (HR 1.50 95%CI 1.11-2.01) and fall-related hospitalization over 12 years (HR 1.53 95%CI 1.13-2.07) compared to Q4 in the multivariable-adjusted model. CONCLUSION These findings support further investigation into the use of Cr:Cyc as a muscle biomarker to help clinicians identify individuals at risk of falls for early inclusion into evidence-based primary prevention programs targeting improvements to diet and exercise.
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Affiliation(s)
- Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Jack Dalla Via
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Bone and Muscle Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia
| | - Wai H Lim
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Jonathan M Hodgson
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, VIC Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard L Prince
- Medical School, University Western Australia, Perth, WA, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Medical School, University Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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21
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Yang Q, Zhang M, Sun P, Li Y, Xu H, Wang K, Shen H, Ban B, Liu F. Cre/CysC ratio may predict muscle composition and is associated with glucose disposal ability and macrovascular disease in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/2/e002430. [PMID: 34732398 PMCID: PMC8572382 DOI: 10.1136/bmjdrc-2021-002430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Since the ratio of creatinine to cystatin C (Cre/CysC) can reflect muscle volume, it has been proven to be a predictor of sarcopenia in patients with or without diabetes. Here, we investigated the predictive value of Cre/CysC for the skeletal muscle composition and its correlations with glucose disposal ability and diabetic complications in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS The skeletal muscle index (SMI) and mean skeletal muscle attenuation (MMA) values of 193 patients with type 2 diabetes were obtained through analyses of CT images at the lumbar 3 level. RESULTS Serum Cre/CysC was significantly correlated with both the SMI (r=0.375, p<0.001) and MMA (r=0.378, p<0.001). Multiple stepwise linear regression analysis demonstrated that Cre/CysC was the only biochemical predictor of the SMI (β=0.48 (95% CI 0.02 to 0.94)) and MMA (β=0.57 (95% CI 0.14 to 1.01)). Furthermore, the fat mass index (FMI) was significantly associated with the MMA (r=-0.481, p<0.001) but not the SMI (r=0.101, p=0.164). In the diabetic complications analysis, Cre/CysC was significantly lower in patients with cardiovascular disease (95% CI (-1.47 to -0.22), p=0.008) and lower extremity arterial disease (95% CI (-1.44 to -0.29), p=0.004). Moreover, in the 100 g steamed bun test, Cre/CysC was significantly correlated with glucose levels at 60 min (r=-0.162, p=0.045), 120 min (r=-0.287, p<0.001) and 180 min (r=-0.313, p<0.001). CONCLUSIONS Cre/CysC may be a valuable predictor of skeletal muscle composition in type 2 diabetes. Patients with a higher Cre/CysC may have a better ability to dispose of postprandial glucose and are at a lower risk of macrovascular disease.
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Affiliation(s)
- Qing Yang
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Mei Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Peng Sun
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yanying Li
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Huichao Xu
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Kejun Wang
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Hongshan Shen
- Department of Nutrition, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Bo Ban
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Fupeng Liu
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
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Kusunoki H, Tabara Y, Tsuji S, Wada Y, Tamaki K, Nagai K, Itoh M, Sano K, Amano M, Maeda H, Sugita H, Hasegawa Y, Kishimoto H, Shimomura S, Igase M, Shinmura K. Estimation of Muscle Mass Using Creatinine/Cystatin C Ratio in Japanese Community-Dwelling Older People. J Am Med Dir Assoc 2021; 23:902.e21-902.e31. [PMID: 34437868 DOI: 10.1016/j.jamda.2021.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Sarcopenia is defined as a combination of low skeletal muscle mass index (SMI), weak muscle strength, and reduced physical function. Recently, many studies have reported that the creatinine/cystatin C ratio (Cr/CysC) is useful for evaluating muscle mass. We designed a cross-sectional study with separate model development and validation groups to develop a prediction equation to estimate bioimpedance analysis (BIA)-measured SMI with Cr/CysC. DESIGN The current study was a retrospective cross-sectional study. SETTING AND PARTICIPANTS The model development group included 908 subjects (288 men and 620 women) from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, and the validation group included 263 subjects (112 men and 151 women) from participants in the medical checkup program at the Anti-Aging Center in Ehime Prefecture. MEASURES Multivariate regression analysis indicated that age, hemoglobin (Hb), body weight (BW), and Cr/CysC were independently associated with SMI in both men and women. The SMI prediction equation was developed as follows: Men:4.17-0.012×Age+1.24×(Cr/CysC)-0.0513×Hb+0.0598×BW Women:3.55-0.00765×Age+0.852×(Cr/CysC)-0.0627×Hb+0.0614×BW RESULTS: The SMI prediction equation was applied to the validation group and strong correlations were observed between the BIA-measured and predicted SMI (pSMI) in men and women. According to the receiver operator characteristic (ROC) analysis, the areas under the curve were 0.93 (specificity 89.0%, sensitivity 87.2%) among men and 0.88 (specificity 83.6%, sensitivity 79.6%) among women for using pSMI to identify low SMI in the model development group. The pSMI also indicated high accuracy in ROC analysis for low SMI in the validation group. The Bland-Altman plot regression showed good agreement between BIA-measured and pSMI. CONCLUSIONS AND IMPLICATIONS Our new prediction equation to estimate SMI is easy to calculate in daily clinical practice and would be useful for diagnosing sarcopenia.
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Affiliation(s)
- Hiroshi Kusunoki
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shotaro Tsuji
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yosuke Wada
- Department of General Medicine and Community Health Science, Sasayama Medical Center Hyogo College of Medicine, Sasayama, Hyogo, Japan; Department of Rehabilitation Medicine, Sasayama Medical Center Hyogo College of Medicine, Sasayama, Hyogo, Japan
| | - Kayoko Tamaki
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koutatsu Nagai
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Masako Itoh
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Kyoko Sano
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Manabu Amano
- School of Pharmacy, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Hatsuo Maeda
- School of Pharmacy, Hyogo University of Health Sciences, Kobe, Hyogo, Japan
| | - Hideyuki Sugita
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoko Hasegawa
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Division of Comprehensive Prosthodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan
| | - Hiromitsu Kishimoto
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Soji Shimomura
- Department of General Medicine and Community Health Science, Sasayama Medical Center Hyogo College of Medicine, Sasayama, Hyogo, Japan
| | - Michiya Igase
- Department of Anti-aging Medicine, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Ken Shinmura
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of General Medicine and Community Health Science, Sasayama Medical Center Hyogo College of Medicine, Sasayama, Hyogo, Japan
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Serum indices based on creatinine and cystatin C predict mortality in patients with non-dialysis chronic kidney disease. Sci Rep 2021; 11:16863. [PMID: 34413438 PMCID: PMC8377030 DOI: 10.1038/s41598-021-96447-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022] Open
Abstract
Serum indices based on creatinine and cystatin C, including creatinine/cystatin C ratio (Cr/CysC), ratio and difference of estimated glomerular filtration rate (eGFR) based on cystatin C and creatinine (eGFRcys/eGFRcre and eGFRDiff), and serum creatinine × eGFRcys, are recently identified serum markers for sarcopenia. We aimed to evaluate the association between these serum indices and mortality in patients with chronic kidney disease (CKD). A single-center retrospective cohort study included 1141 adult patients with stage 1–5 CKD between 2016 and 2018. Basic characteristics, comorbidities, laboratory parameters, and serum creatinine and cystatin C values were obtained. Patients were followed up until death, dialysis, transfer to another hospital, or end of the study. The median age (interquartile range) of our participants was 71 (62–81) years. During a median follow-up of 39 months, 116 (10.2%) patients died. Compared to the survivor group, Cr/CysC, eGFRcys/eGFRcre, eGFRDiff, and Cr × eGFRcys were all lower in the non-survivors (p < 0.001 for all). The receiver operating characteristic curves of serum indices for predicting mortality showed that all four indices had significant discriminative power. Based on the Cox proportional hazard models, lower values of four serum indices, both as continuous and categorical variables, independently predicted mortality. Our findings suggest that low serum indices of Cr/CysC, eGFRcys/eGFRcre, eGFRDiff, and Cr × eGFRcys are independent indicators of mortality in patients with non-dialysis CKD.
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Associations of creatinine/cystatin C ratio and postoperative pulmonary complications in elderly patients undergoing off-pump coronary artery bypass surgery: a retrospective study. Sci Rep 2021; 11:16881. [PMID: 34413410 PMCID: PMC8376894 DOI: 10.1038/s41598-021-96442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022] Open
Abstract
Sarcopenia along with nutritional status are associated with postoperative pulmonary complications in various surgical fields. Recently, the creatinine/cystatin C ratio and CONtrolling NUTritional status score were introduced as biochemical indicators for sarcopenia and malnutrition, respectively. We aimed to investigate the associations among these indicators and postoperative pulmonary complications in elderly patients undergoing off-pump coronary artery bypass surgery. We reviewed the medical records of 605 elderly patients (aged ≥ 65 years) who underwent off-pump coronary artery bypass surgery from January 2010 to December 2019. Postoperative pulmonary complications (pneumonia, prolonged ventilation [> 24 h], and reintubation during post-surgical hospitalisation) occurred in 80 patients. A 10-unit increase of creatinine/cystatin C ratio was associated with a reduced risk of postoperative pulmonary complications (odds ratio: 0.80, 95% confidence interval: 0.69–0.92, P = 0.001); the optimal cut-off values for predicting postoperative pulmonary complications was 89.5. Multivariable logistic regression analysis revealed that age, congestive heart failure, and creatinine/cystatin C ratio < 89.5 (odds ratio 2.36, 95% confidence interval 1.28–4.37) were independently associated with the occurrence of postoperative pulmonary complications, whereas CONtrolling NUTritional status score was not. A low creatinine/cystatin C ratio was associated with an increased risk of developing postoperative pulmonary complications after off-pump coronary artery bypass surgery.
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Relationships between cystatin C- and creatinine-based eGFR in Japanese rural community- dwelling older adults with sarcopenia. Clin Exp Nephrol 2020; 25:231-239. [PMID: 33090338 PMCID: PMC7925493 DOI: 10.1007/s10157-020-01981-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sarcopenia is prevalent in patients with chronic kidney disease (CKD). The indices of physical function, such as grip power and gait speed, decreased according to the decline in the estimated glomerular filtration rate (eGFR). METHODS We examined the relationships between cystatin C-based GFR (eGFRcys), creatinine-based GFR (eGFRcre), their ratio (eGFRcys/eGFRcre) and sarcopenia in community-dwelling older adults in Japan. This cross-sectional study included 302 men aged 73.9 ± 6.2 years and 647 women aged 72.9 ± 5.8 years from a rural area in Hyogo Prefecture, Japan. eGFRcys and eGFRcre were simultaneously measured, and sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) 2019 criteria was evaluated. RESULTS eGFRcys and the eGFRcys/eGFRcre ratio were significantly correlated with grip power and gait speed (p < 0.001). The eGFRcys/eGFRcre ratio was also correlated with skeletal muscle mass index (SMI) (p < 0.01). Univariate logistic regression analysis showed eGFRcys and eGFRcys/eGFRcre ratio but not eGFRcre were associated with sarcopenia (p < 0.01). The presence of low eGFRcys (CKDcys) and low eGFRcys/eGFRcre ratio (< 1.0) but not that of low eGFRcre (CKDcre) were associated with sarcopenia (p < 0.01). In the multivariate logistic regression analysis, when the eGFRcys/eGFRcre ratio was added as a covariate to the basic model, it was significantly associated with sarcopenia in women (p < 0.05). Moreover, low eGFRcys/eGFRcre ratio (< 1.0) was associated with a higher risk of sarcopenia in men (p < 0.01). CONCLUSION In conclusion, CKDcys but not CKDcre is associated with sarcopenia. A lower eGFRcys/eGFRcre ratio may be a practical screening marker of sarcopenia in community-dwelling older adults.
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Jung CY, Joo YS, Kim HW, Han SH, Yoo TH, Kang SW, Park JT. Creatinine-Cystatin C Ratio and Mortality in Patients Receiving Intensive Care and Continuous Kidney Replacement Therapy: A Retrospective Cohort Study. Am J Kidney Dis 2020; 77:509-516.e1. [PMID: 33098923 DOI: 10.1053/j.ajkd.2020.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE & OBJECTIVE Studies have suggested associations between lower ratios of serum creatinine to cystatin C with both lower muscle mass and adverse clinical outcomes in multiple disease conditions. Identifying risk factors for mortality among patients with acute kidney injury (AKI) undergoing continuous kidney replacement therapy (CKRT) may improve assessment of prognosis. We sought to evaluate the association of creatinine-cystatin C ratio with outcomes in patients with AKI undergoing CKRT. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 1,588 patients treated with intensive care and CKRT for AKI at a tertiary Korean medical center. PREDICTOR Baseline serum creatinine-cystatin C ratio at the time of CKRT initiation. OUTCOMES Age- and sex-adjusted 90-day mortality after CKRT initiation. ANALYTICAL APPROACH Cox proportional hazard models to estimate the association between creatinine-cystatin C ratio and outcome. RESULTS Mean age was 64.7 ± 14.5 years and 635 patients (40.0%) were women. The range of creatinine-cystatin C ratios was 0.08 to 10.48. The 30- and 90-day mortality rates were significantly lower for the higher creatinine-cystatin C ratio groups. Multivariable Cox proportional hazards regression analyses revealed that mortality risk became successively lower across quartiles of greater creatinine-cystatin C ratio. When creatinine-cystatin C ratio was evaluated using cubic spline analyses, risks for both 30- and 90-day mortality were lower with higher creatinine-cystatin C ratios. These associations remained significant even after adjustment for confounding variables. LIMITATIONS Retrospective analysis, serum creatinine and cystatin C may not be in steady state in the setting of AKI. CONCLUSIONS Higher serum creatinine-cystatin C ratios were associated with better survival in patients receiving intensive care and CKRT.
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Affiliation(s)
- Chan-Young Jung
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Young Su Joo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
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Lee HS, Park KW, Kang J, Ki YJ, Chang M, Han JK, Yang HM, Kang HJ, Koo BK, Kim HS. Sarcopenia Index as a Predictor of Clinical Outcomes in Older Patients with Coronary Artery Disease. J Clin Med 2020; 9:E3121. [PMID: 32992530 PMCID: PMC7600792 DOI: 10.3390/jcm9103121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
To demonstrate the association of the serum creatinine/serum cystatin C ratio (sarcopenia index, SI) with clinical outcomes including cardiovascular and bleeding risk in older patients who underwent percutaneous coronary intervention (PCI), we analyzed a multicenter nation-wide pooled registry. A total of 1086 older patients (65 years or older) who underwent PCI with second-generation drug-eluting stents (DES) were enrolled. The total population was divided into quartiles according to the SI, stratified by sex. The primary clinical outcomes were major adverse cardiovascular events (MACE, all-cause death, myocardial infarction and target lesion revascularization) and thrombolysis in myocardial infarction major and minor bleeding during a 3-year follow-up period. In the total population, MACE occurred within 3 years in 154 (14.2%) patients. The lowest SI quartile group (Q1) had a significantly higher 3-year MACE rate (Q1 vs. Q2-4; 23.1% vs. 11.2%, p < 0.001), while bleeding event rates were similar between the groups (Q1 vs. Q2-4; 2.6% vs. 2.2%, p = 0.656). The Cox proportional hazard model showed that lower SI is an independent predictor for MACE events (HR 2.23, 95% CI 1.62-3.07, p < 0.001). The SI, a surrogate for the degree of muscle mass, is associated with cardiovascular and non-cardiovascular death, but not with bleeding in older patients who underwent PCI.
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Affiliation(s)
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Korea; (H.S.L.); (J.K.); (Y.-J.K.); (M.C.); (J.-K.H.); (H.-M.Y.); (H.-J.K.); (B.-K.K.); (H.-S.K.)
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Yamamoto S, Matsuzawa R, Hoshi K, Suzuki Y, Harada M, Watanabe T, Isobe Y, Imamura K, Osada S, Yoshida A, Kamiya K, Matsunaga A. Modified Creatinine Index and Clinical Outcomes of Hemodialysis Patients: An Indicator of Sarcopenia? J Ren Nutr 2020; 31:370-379. [PMID: 32952008 DOI: 10.1053/j.jrn.2020.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Sarcopenia (especially muscle mass assessed using gold standard techniques) has been suggested as a poorer predictor of mortality than muscle function in patients undergoing hemodialysis. Appropriate methods to estimate muscle mass for use as a good predictor of clinical outcomes remain to be established. We investigated whether the modified creatinine index (mCI), which is a surrogate marker of muscle mass, could predict mortality and cardiovascular (CV) hospitalizations independent of muscle function and other confounders in patients on hemodialysis. DESIGN AND METHODS In this retrospective study, outpatients (n = 542; mean age, 65.3 years; 60% men; median dialysis vintage, 29 months; mean BMI, 22.0 kg/m2) undergoing hemodialysis were investigated. The mCI, handgrip strength, and gait speed were assessed and related to all-cause mortality and a composite of CV hospitalizations and all-cause mortality. Cox proportional and mixed-effects negative binomial models were fit for mortality and the composite outcomes. RESULTS Patients were followed up for a median 3 years (interquartile range: 1.5-5.7). Each per SD increase of mCI (HR:0.63, 95% CI:0.62-0.65), handgrip strength (HR:0.51, 95% CI:0.48-0.54), and gait speed (HR:0.60, 95% CI:0.56-0.64) were significantly associated with lower all-cause mortality rates after adjusting for covariates. The mCI was consistently found to be an independent predictor of mortality after additional adjustment for handgrip strength or gait speed. Furthermore, sarcopenic conditions [i.e., lower mCI, and lower handgrip strength (HR:3.79, 95% CI:2.09-6.87) or slower gait speed (HR:4.20, 95% CI:2.38-7.41)] were significantly associated with a higher risk of mortality after adjusting for covariates. Associations of mCI with multiple CV hospitalizations and mortality were similar to those between mCI and mortality. CONCLUSION The mCI was a good predictor of clinical outcomes and was comparable to muscle function, including handgrip strength and gait speed. The mCI is likely to provide additional diagnostic and prognostic values for sarcopenia in patients on hemodialysis.
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Affiliation(s)
- Shohei Yamamoto
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Hyogo, Japan
| | - Keika Hoshi
- Center for Public Health Informatics, National Institute of Public Health, Saitama, Japan; Department of Hygiene, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yuta Suzuki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Takaaki Watanabe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Yusuke Isobe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Keigo Imamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Kanagawa, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
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Tabara Y, Kohara K, Okada Y, Ohyagi Y, Igase M. Creatinine-to-cystatin C ratio as a marker of skeletal muscle mass in older adults: J-SHIPP study. Clin Nutr 2020; 39:1857-1862. [DOI: 10.1016/j.clnu.2019.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/08/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
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Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients. Sci Rep 2020; 10:1260. [PMID: 31988356 PMCID: PMC6985114 DOI: 10.1038/s41598-020-58304-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
To investigate the association of the sarcopenia index (SI, serum creatinine value/cystatin C value × 100) with 3-year mortality and readmission among older inpatients, we reanalyzed a prospective study in the geriatric ward of a teaching hospital in western China. Older inpatients aged ≥ 60 years with normal kidney function were included. Survival status and readmission information were assessed annually during the 3-year follow-up. We applied Cox regression models to calculate the hazard ratio (HR) and 95% confidence intervals (CIs) of sarcopenia for predicting mortality and readmission. We included 248 participants (mean age: 81.2 ± 6.6 years). During the follow-up, 57 participants (23.9%) died, whereas 179 participants (75.2%) were readmitted at least one time. The SI was positively correlated with body mass index (BMI) (r = 0.214, p = 0.001), calf circumference (CC) (r = 0.253, p < 0.001), handgrip strength (r = 0.244, p < 0.001), and gait speed (r = 0.221, p < 0.001). A higher SI was independently associated with a lower risk of 3-year all-cause mortality after adjusting for potential confounders (HR per 1-SD = 0.80, 95% CI: 0.63–0.97). The SI was not significantly associated with readmission (HR per 1-SD = 0.97, 95% CI: 0.77–1.25). In conclusion, the SI is associated with 3-year all-cause mortality but not readmission in a study population of hospitalized older patients.
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