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Vaccarino R, Wachtmeister M, Karelis A, Marinko E, Sun J, Resch T, Sonesson B, Dias NV. The role of CT-assessed sarcopenia and visceral adipose tissue in predicting long-term survival in patients undergoing elective endovascular infrarenal aortic repair. Br J Radiol 2024; 97:1461-1466. [PMID: 38848475 PMCID: PMC11256935 DOI: 10.1093/bjr/tqae114] [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] [Received: 03/04/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVES To evaluate if ileo-psoas muscle size and visceral adipose tissue (VAT) can predict long-term survival after endovascular aneurysm repair (EVAR). METHODS Patients who underwent EVAR between 2004 and 2012 in a single centre were included. Total psoas muscle area (TPA), abdominal VAT area, subcutaneous adipose tissue (SAT), and total adipose tissue were measured on the preoperative CT. Primary endpoint was all-cause mortality. Values are presented as median and interquartile range or absolute number and percentage. Cox regression analyses were performed to assess the associations with mortality. RESULTS Two hundred and eighty-four patients could be included in the study. During a median follow-up of 8 (4-11) years, 223 (79.9%) patients died. Age (P ≤ .001), cardiovascular (P = .041), cerebrovascular (P = .009), renal diseases (P = .002), and chronic obstructive pulmonary disease (P ≤ .001) were independently associated with mortality. TPA was associated with mortality in a univariate (P = .040), but not in a multivariate regression model (P = .764). No significant association was found between mortality and TPA index (P = .103) or any of the adiposity measurements with the exception of SAT (P = .040). However, SAT area loss in a multivariate analysis (P = .875). CONCLUSIONS Assessment of core muscle size and VAT did not contribute to improving the prediction of long-term survival after EVAR. ADVANCES IN KNOWLEDGE The finding of this study contradicts the previously claimed utility of core muscle size and VAT in predicting long-term survival after EVAR.
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Affiliation(s)
- Roberta Vaccarino
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | | | - Angelos Karelis
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Elisabet Marinko
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Jianming Sun
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
| | - Timothy Resch
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Vascular Surgery, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Health and Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
| | - Björn Sonesson
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
| | - Nuno V Dias
- Department of Clinical Sciences Malmö, Lund University, Malmö 21428, Sweden
- Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skane University Hospital, Malmö 21428, Sweden
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Sachsamanis G, Stahl J, Pfister K, Schierling W, Betz T, Jage S. The Impact of Sarcopenia in the Long-Term Survival of Patients following Complex Endovascular Aortic Surgery for Thoracoabdominal Aortic Aneurysms. Diagnostics (Basel) 2024; 14:751. [PMID: 38611664 PMCID: PMC11011763 DOI: 10.3390/diagnostics14070751] [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: 02/09/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES Image-based sarcopenia has been the subject of recent studies, hypothesized as a prognostic factor for patients with thoracoabdominal aortic aneurysms. METHODS AND MATERIALS We conducted a single-center retrospective analysis of patients who underwent complex endovascular repair for thoracoabdominal aortic aneurysms between 2008 and 2016. CT image assessment was performed and patients were classified as sarcopenic and non-sarcopenic using two stratification methods: skeletal mass index (SMI) and total psoas muscle index (TPMI). According to sex, each patient was defined as sarcopenic if their SMI or TPMI was in the lowest third of the study group. The primary endpoint was impact of sarcopenia on perioperative mortality and long-term survival. Secondary endpoints were perioperative complications. RESULTS From a total of 155 patients, 135 were eligible for study. Overall, in-hospital mortality was 5.9% (8/135). The 30-day, 1-year, 3-year and 5-year mortality was 10.4% (14/135), 20% (27/135), 28.1% (38/135) and 31.1% (42/135), respectively. There was no difference in the long-term mortality rates between sarcopenic and non-sarcopenic patients regardless of the stratification method used (p = 0.4 for SMI and p = 0.2 for TPMI). According to SMI, 30-day mortality of sarcopenic patients was significantly lower in comparison to non-sarcopenic patients (1/45, 2.2% vs. 13/90, 14.4%, p = 0.028). Based on the total psoas muscle index, sarcopenic patients were at higher risk for development of pulmonary complications in comparison to non-sarcopenic patients postoperatively (p = 0.03). CONCLUSION Using SMI and TPMI, sarcopenia was not associated with reduced long-term survival in patients undergoing complex endovascular repair for thoracoabdominal aortic aneurysms.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Judith Stahl
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (J.S.); (K.P.); (W.S.); (T.B.)
| | - Simon Jage
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
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Saucy F, Probst H, Hungerbühler J, Maufroy C, Ricco JB. Impact of Frailty and Sarcopenia on Thirty-Day and Long-Term Mortality in Patients Undergoing Elective Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1935. [PMID: 38610700 PMCID: PMC11012666 DOI: 10.3390/jcm13071935] [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: 02/23/2024] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The aim of this study was to assess the prognostic role of frailty and sarcopenia on the survival of patients with AAA undergoing elective endovascular repair (EVAR). Methods: A systematic review of the literature was conducted in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE). The association of frailty or sarcopenia with 30-day mortality and late survival was expressed as odds ratios (ORs) or hazard ratios (HRs) with a 95% confidence interval (CI). Meta-analysis random effects models were applied. The five-factor modified frailty index (mFI-5) was used as a frailty metric and sarcopenia was determined using computed tomography angiography (CTA) with measurements of the total psoas muscle area. Frailty was defined as patients with mFI-5 ≥ 0.6 and sarcopenia was defined as the total psoas muscle area (TPA) within the lowest tertile. Results: Thirteen observational cohorts reporting a total of 56,756 patient records were eligible for analysis. Patients with frailty (mFI-5 ≥ 0.6) had significantly increased 30-day mortality than those without frailty (random effects method: OR, 4.84, 95% CI 3.34-7.00, p < 0.001). Patients with sarcopenia (lowest TPA tertile) had significantly increased 30-day mortality according to the fixed effects method (OR, 3.30, 95% CI 2.17-5.02, p < 0.001), but not the random effects method (OR, 2.64, 95% CI 0.83-8.39, p = 0.098). Patients with sarcopenia or frailty had a significantly increased hazard ratio (HR) for late mortality than those without frailty or sarcopenia according to the random effects method (HR, 2.39, 95% CI 1.66-3.43, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.86). The relation of frailty to age extracted from four studies demonstrates that the risk of frailty increases with age according to the random effects method (standard mean differences, SMD, 0.52, 95% CI 0.44-0.61, p < 0.001). The heterogeneity of the studies was low (I2: 0.00%, p = 0.64). Conclusions: Patients with sarcopenia or frailty have a significantly increased risk of mortality following elective EVAR. Prospective studies validating the use of frailty and sarcopenia for risk prediction after EVAR are needed before these tools can be used to support decision making.
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Affiliation(s)
- François Saucy
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Hervé Probst
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Johan Hungerbühler
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
| | - Coralie Maufroy
- Service de Chirurgie Vasculaire, Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges, Switzerland; (H.P.); (J.H.); (C.M.)
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Knoedler S, Schliermann R, Knoedler L, Wu M, Hansen FJ, Matar DY, Obed D, Vervoort D, Haug V, Hundeshagen G, Paik A, Kauke-Navarro M, Kneser U, Pomahac B, Orgill DP, Panayi AC. Impact of sarcopenia on outcomes in surgical patients: a systematic review and meta-analysis. Int J Surg 2023; 109:4238-4262. [PMID: 37696253 PMCID: PMC10720826 DOI: 10.1097/js9.0000000000000688] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. METHODS The authors systematically assessed the prognostic value of sarcopenia on postoperative outcomes by conducting a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching the PubMed/MEDLINE and EMBASE databases from inception to 1st October 2022. Their primary outcomes were complication occurrence, mortality, length of operation and hospital stay, discharge to home, and postdischarge survival rate at 1, 3, and 5 years. Subgroup analysis was performed by stratifying complications according to the Clavien-Dindo classification system. Sensitivity analysis was performed by focusing on studies with an oncological, cardiovascular, emergency, or transplant surgery population and on those of higher quality or prospective study design. RESULTS A total of 294 studies comprising 97 643 patients, of which 33 070 had sarcopenia, were included in our analysis. Sarcopenia was associated with significantly poorer postoperative outcomes, including greater mortality, complication occurrence, length of hospital stay, and lower rates of discharge to home (all P <0.00001). A significantly lower survival rate in patients with sarcopenia was noted at 1, 3, and 5 years (all P <0.00001) after surgery. Subgroup analysis confirmed higher rates of complications and mortality in oncological (both P <0.00001), cardiovascular (both P <0.00001), and emergency ( P =0.03 and P =0.04, respectively) patients with sarcopenia. In the transplant surgery cohort, mortality was significantly higher in patients with sarcopenia ( P <0.00001). Among all patients undergoing surgery for inflammatory bowel disease, the frequency of complications was significantly increased among sarcopenic patients ( P =0.007). Sensitivity analysis based on higher quality studies and prospective studies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). CONCLUSION Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.
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Affiliation(s)
- Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Rainer Schliermann
- Faculty of Social and Health Care Sciences, University of Applied Sciences Regensburg, Regensburg
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Frederik J. Hansen
- Department of General and Visceral Surgery, Friedrich-Alexander University Erlangen, Erlangen
| | - Dany Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Angie Paik
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, USA
| | - Dennis P. Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston
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Becchetti C, Berzigotti A. Ultrasonography as a diagnostic tool for sarcopenia in patients with cirrhosis: Examining the pros and cons. Eur J Intern Med 2023; 116:27-33. [PMID: 37385916 DOI: 10.1016/j.ejim.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/13/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Sarcopenia has emerged as a significant prognostic factor in liver disease, posing a significant risk to patients in terms of morbidity and mortality. However, the evaluation of skeletal muscle mass and quality remains challenging, as cross-sectional imaging is not a suitable screening tool. In order to better include this crucial variable in the routine risk stratification of patients with chronic liver disease, there is an urgent need for simple and reliable non-invasive diagnostic tools for sarcopenia. Therefore, the use of ultrasound techniques has garnered attention as a promising alternative for detecting sarcopenia and muscle abnormalities. This narrative review aims to provide an overview of the current literature on the use of ultrasound as a diagnostic tool for sarcopenia, with particular focus on patients with cirrhosis, emphasizing its potential limitations and future prospects.
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Affiliation(s)
- Chiara Becchetti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Hepatology and Gastroenterology Division, ASST Grande Ospedale Metropolitano Niguarda, Niguarda Hospital, Milan, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland.
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Järvinen O, Tynkkynen JT, Virtanen M, Maaranen P, Lindström I, Vakhitov D, Laurikka J, Oksala NK, Hernesniemi JA. Psoas muscle quantified muscle status and long-term mortality after cardiovascular interventions. Ann Med 2023; 55:2259798. [PMID: 37738519 PMCID: PMC10519254 DOI: 10.1080/07853890.2023.2259798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
RESULTS In the meta-analysis, psoas muscle measurements were significantly associated with mortality among men (p < 0.05), with high heterogeneity in the associations across all cohorts. There was very little difference in the association between PMA and PMD and mortality (HR 0.83, 95% CI 0.69-0.99, p = 0.002; HR 0.85, 95% CI 0.77-0.94, p = 0.041 for one SD increase in PMA and PMD in the random effects model). Combining PMA and PMD into one composite variable by multiplying their values together showed the most robust association in terms of the magnitude of the effect size in men (HR, 0.77; 95% CI 0.73-0.87, p < 0.001). Indexing PMA to body size did not result in any significant differences in this association. Among women, psoas muscle measurements were not associated with long-term mortality in this meta-analysis. CONCLUSIONS Different psoas muscle measurements were significantly and very similarly associated with mortality among men but not among women. No single measurement stands out, although combining PMA and PMD seems to be a slightly stronger estimate in terms of effect size and should be considered in further studies.
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Affiliation(s)
- Otto Järvinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre Tampere, Tampere, Finland
| | - Juho T. Tynkkynen
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Marko Virtanen
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Iisa Lindström
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Damir Vakhitov
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jari Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre Tampere, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Niku K. Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre Tampere, Tampere, Finland
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi A. Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Cardiovascular Research Centre Tampere, Tampere, Finland
- Heart Hospital, Tampere University Hospital, Tampere, Finland
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Geng D, Wu X, Wang Y, He J, Hu X. Sarcopenia defined by the psoas muscle mass or quality is associated with poor survival in patients with aortic aneurysm undergoing surgery: A meta-analysis. Ageing Res Rev 2023; 88:101964. [PMID: 37247820 DOI: 10.1016/j.arr.2023.101964] [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: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The impact of sarcopenia estimated by the skeletal muscle mass or quality on survival remains controversial in patients with aortic aneurysm. This meta-analysis aimed to assess the association between sarcopenia defined by the psoas muscle mass or quality and all-cause mortality in patients with aortic aneurysm. METHODS We comprehensively searched PubMed, Web of Science, and Embase databases until December 31, 2022. Studies investigating the association of CT-derived psoas muscle mass (psoas muscle area [PSA] and psoas muscle index [PMI]) or quality (lean PSA [LPSA]) with all-cause mortality in patients with aortic aneurysm undergoing surgery were included. RESULTS Eighteen studies reporting on 19 articles, enrolling 4767 patients were identified. A comparison of the bottom with the top psoas muscle mass, the pooled adjusted hazard ratios (HR) of all-cause mortality was 2.34 (95% confidence intervals [CI] 1.58-3.47). Low psoas muscle mass was associated with an increased risk of all-cause mortality when defined by the PSA (HR 2.01; 95% CI 1.42-2.75) or PMI (HR 2.37; 95% CI 1.24-4.55). Per 1 cm2 PMA increase conferred a 10% reduction in all-cause mortality. Patients with bottom LPMA had an increased risk of all-cause mortality (HR 3.27; 95% CI 1.90-5.60). Each 100 cm2 × HU LPMA increase conferred a 15% reduction in all-cause mortality. CONCLUSIONS Sarcopenia defined by the low psoas muscle mass or quality independently predicts all-cause mortality in patients with aortic aneurysm. However, the overall certainty of evidence for the categorical analysis of psoas muscle mass was downgraded by the presence of publication bias and significant heterogeneity.
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Affiliation(s)
- Donghua Geng
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xinyue Wu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Yuxin Wang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Jiaan He
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China.
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Forte-Genescà P, Casajuana Urgell E, Díaz-Duran C, Romero-Montaña L, Paredes-Mariñas E, Clarà-Velasco A. Comparison Between Several CT-Derived Psoas Muscle Sarcopenia Markers for Predicting Survival After Abdominal Aortic Aneurysm Repair. World J Surg 2023; 47:1073-1079. [PMID: 36611098 DOI: 10.1007/s00268-022-06868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Multiple CT-derived measurements of sarcopenia have been described yet their relationship with survival after abdominal aortic aneurysm (AAA) repair has not been properly assessed. We aimed to define and compare the relationship between several psoas CT-derived measurements and the 5-year survival after AAA repair and to evaluate their potential contribution to survival prediction. METHODS Preoperative CT area (TPA) and density (MTPD) of the psoas muscle at L3 were measured in 218 consecutive AAA patients electively intervened. Additional measurements were obtained by normalizing TPA by anthropometric data or L3-vertebra surface or by TPAxMTPD multiplication (lean psoas muscle area-LPMA). The association of sarcopenia markers with survival was evaluated with Cox models adjusted by age, sex, type of intervention and the Charlson Comorbidity Index, and their contribution to survival prediction assessed with the C-statistic and the Continuous Net Reclassification Index (c-NRI). RESULTS Sixty patients (27.5%) died during the first 5 years after surgery. There was a statistically significant and linear (spline analysis) relationship of sarcopenia markers with 5-year survival in all multivariate models, except that including LPMA. Despite this association, the inclusion of sarcopenia markers did not improve the C-statistic and moderately increased the c-NRI. None normalized sarcopenia markers performed better than TPA. CONCLUSION The majority of CT-derived psoas muscle measurements of sarcopenia showed a significant and independent relationship with survival after elective AAA repair. Despite this association, they did not appear to improve sufficiently our survival prediction ability to become an efficient tool for decision-making.
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Affiliation(s)
- Pau Forte-Genescà
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Eduard Casajuana Urgell
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Díaz-Duran
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lorena Romero-Montaña
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Ezequiel Paredes-Mariñas
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Clarà-Velasco
- Department of Vascular and Endovascular Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Department of Life and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,CIBER Cardiovascular, IMIM - Parc de Salut Mar, Barcelona, Spain.
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Loria A, Glance LG, Melucci AD, Boodry C, Justiniano CF, Dunne RF, Mustian KM, Becerra AZ, Jusko TA, Temple LK, Fleming FJ. Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery. Ann Surg 2023; 277:246-251. [PMID: 36448909 DOI: 10.1097/sla.0000000000005760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess the association between low preoperative serum creatinine and postoperative outcomes. BACKGROUND The association between low creatinine and poor surgical outcomes is not well understood. METHODS We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications. RESULTS Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively. CONCLUSIONS A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.
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Affiliation(s)
- Anthony Loria
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York.,RAND Health, Rand, Boston, MA
| | - Alexa D Melucci
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Courtney Boodry
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Carla F Justiniano
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Richard F Dunne
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Karen M Mustian
- Department of Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Todd A Jusko
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Larissa K Temple
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York
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10
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Mezzetto L, D'Oria M, Mani K, Scali S, Bastos Gonçalves F, Trimarchi S, Budtz-Lilly J, DeMartino R, Veraldi G, Mastrorilli D, Calvagna C, Grando B, Bissacco D, Lepidi S. Scoping review of radiologic assessment and prognostic impact of skeletal muscle sarcopenia in patients undergoing endovascular repair for aortic disease. J Vasc Surg 2022; 76:1407-1416. [PMID: 35667604 PMCID: PMC9613481 DOI: 10.1016/j.jvs.2022.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The primary objectives of our scoping review were to evaluate the methods used by research groups to assess the incidence of sarcopenia in patients with aortic disease and the extent of the evidence base that links sarcopenia to the survival of patients undergoing elective endovascular aortic repair and to identify the recurring themes or gaps in the literature to guide future research. METHODS A scoping review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocols extension for scoping reviews was performed. The available studies included those fully reported in English (last query, April 30, 2022). The following PICO question was used to build the search equation: "in patients with aortic disease [population] undergoing endovascular repair [intervention], what was the prevalence and prognosis of radiologically defined sarcopenia [comparison] on the short- and long-term outcomes?" RESULTS A total of 31 studies were considered relevant, and 18 were included in the present scoping review. In brief, 12 studies had focused on standard endovascular aneurysm repair (EVAR), 2 on thoracic EVAR, and 4 on complex EVAR. All but two studies were retrospective in design, and only one study had included patients from a multicenter database. Sarcopenia had generally been defined using the computed tomography angiography (CTA) findings of the cross-sectional area of the psoas muscle at L3 or L4, sometimes with normalization against the height. Overall, despite the heterogeneity in the methods used for its definition, sarcopenia was highly prevalent (range, 12.5%-67.6%). The patients with sarcopenia had had higher rates of mortality (ratio ranged from 2.28 [95% confidence interval, 1.35-3.84] to 6.34 [95% confidence interval, 3.37-10.0]) and adverse events (41% vs 16%; P = .020). CONCLUSIONS Sarcopenia, as identified using computed tomography angiography-based measurements of the skeletal muscle mass, was prevalent among patients undergoing elective EVAR, thoracic EVAR, or complex EVAR. The presence of sarcopenia has been shown to have a negative prognostic impact, increasing the operative risk and has been linked to poorer long-term survival.
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Affiliation(s)
- Luca Mezzetto
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy.
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Santi Trimarchi
- Division of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic Rochester Campus, Rochester, MN
| | - Gianfranco Veraldi
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Davide Mastrorilli
- Unit of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Beatrice Grando
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Daniele Bissacco
- Division of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
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11
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Bradley NA, Roxburgh CSD, McMillan DC, Guthrie GJK. The relationship between pre-operative psoas and skeletal muscle parameters and survival following endovascular aneurysm repair: a systematic review and meta-analysis. Sci Rep 2022; 12:16663. [PMID: 36198699 PMCID: PMC9534993 DOI: 10.1038/s41598-022-20490-3] [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: 04/26/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Abstract
Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67–4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66–5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.
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12
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Doonan R, Bin-Ayeed S, Charbonneau P, Hongku K, Obrand D, Mackenzie K, Steinmetz O, Bayne J, Girsowicz E, Abraham C, Gill H. Low Psoas Muscle Area is Associated with Increased Mortality and Spinal Cord Injury after Complex Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2022; 87:430-436. [DOI: 10.1016/j.avsg.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 11/01/2022]
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13
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Paajanen P, Lindström I, Oksala N, Väärämäki S, Saari P, Mäkinen K, Kärkkäinen JM. Radiographically Quantified Sarcopenia and Traditional Cardiovascular Risk Assessment in Predicting Long-term Mortality after EVAR. J Vasc Surg 2022; 76:908-915.e2. [PMID: 35367563 DOI: 10.1016/j.jvs.2022.03.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/14/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study evaluated radiographically quantified sarcopenia and patient's comorbidity burden based on traditional cardiovascular risk assessment as potential predictors of long-term mortality after endovascular aortic repair (EVAR). METHODS The study included 480 patients treated with standard EVAR for intact infrarenal abdominal aortic aneurysms. Patient characteristics, comorbidities, aneurysm dimensions and other preoperative risk factors were collected retrospectively. Preoperative computed tomography was used to measure psoas muscle area (PMA) at L3 level. Patients were divided into three groups based on ASA-score and PMA. In high-risk group, patients had sarcopenia (PMA <8.0 cm2 for males and <5.5 cm2 for females) and ASA score 4. In medium-risk group, patients had either sarcopenia or ASA 4. Patients in the low-risk group had no sarcopenia and ASA score was less than 4. Risk factors for long-term mortality were determined using multivariable analysis. Kaplan-Meier survival estimates were calculated for all-cause mortality. RESULTS Patients in the high- and medium risk-groups were older than in the low-risk group (77±7, 76±6 and 74±8 years, respectively, p<0.01). Patients in the high-risk group had higher prevalence of coronary artery disease, pulmonary disease and chronic kidney disease. There were no differences in 30-day or 90-day mortality between the groups. The independent predictors of long-term mortality were age, ASA-score, PMA, chronic kidney disease and maximum aneurysm sac diameter. The estimated one-year mortality rates were 5±2% for the low-risk, 5±2% for the medium-risk and 18±5% for the high-risk group (p<0.01). Five-year mortality estimates were 23±4%, 36±3% and 60±6%, respectively (p<0.01). The mean follow-up time was 5.0±2.8 years. CONCLUSIONS Both ASA and PMA were strong predictors of increased mortality after elective EVAR. The combination of these two can be used as a simple risk stratification tool to identify patients in whom aneurysm repair or the intensive long-term surveillance after EVAR may be unwarranted.
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Affiliation(s)
- Paavo Paajanen
- Heart Center, Kuopio University Hospital, Kuopio, Finland; Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
| | - Iisa Lindström
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Vascular Centre, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Finland
| | - Suvi Väärämäki
- Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Finland
| | - Kimmo Mäkinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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14
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Dakis K, Nana P, Brodis A, Kouvelos G, Behrendt CA, Giannoukas A, Kölbel T, Spanos K. Sarcopenia is a prognostic biomarker for long-term survival after endovascular aortic aneurysm repair: A systematic review and meta-analysis. Ann Vasc Surg 2022; 83:358-368. [DOI: 10.1016/j.avsg.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/19/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022]
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15
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Ouchi T, Kato N, Kato H, Higashigawa T, Ito H, Nakajima K, Chino S, Tokui T, Oue K, Mizumoto T, Sakuma H. Utility of psoas muscle area in selecting older patients feasible for thoracic endovascular aortic repair. Ann Thorac Surg 2022; 114:750-756. [PMID: 35216989 DOI: 10.1016/j.athoracsur.2022.01.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/04/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND The impact of psoas muscle mass index (PMI) on overall survival is unknown in older patients undergoing elective thoracic endovascular aortic repair (TEVAR). METHODS We retrospectively reviewed 105 patients 75 years and older who underwent elective TEVAR for descending thoracic aortic aneurysm between January 2010 and December 2019. Psoas muscle area was measured at the L3 level with preoperative computed tomography and adjusted by height2 to derive PMI. The patients were stratified into two groups, Sarcopenia and Non-sarcopenia. Sarcopenia was defined as a PMI < 5.40 cm2/m2 for male and < 3.56 cm2/m2 for female. The overall survival was compared with the age- and sex-matched general population using the one-sample log-rank test. The propensity score adjusted-Cox proportional-hazard model was applied to determine the hazard ratio for all-cause mortality. RESULTS Twenty-three patients died during the follow-up period (median, 3.0 years). Thirty-eight (36%) patients were classified as Sarcopenia. The 5-year overall survival rate was 46% (95% confidence interval, 29-73) in Sarcopenia and 84% (95% confidence interval, 74-94) in Non-sarcopenia. The overall survival was significantly lower in Sarcopenia than in its matched general population (P = .004). Whereas, no statistically significant difference in overall survival was found between Non-sarcopenia and its matched general population (P = .417). Sarcopenia was an independent risk factor for all-cause mortality (adjusted hazard ratio, 2.64; 95% confidence interval, 1.02- 6.82; P = .045). CONCLUSIONS PMI may be a good predictor of mortality in older patients undergoing elective TEVAR for descending thoracic aortic aneurysm.
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Affiliation(s)
- Takafumi Ouchi
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan.
| | - Hiroaki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | | | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, Tsu, Mie, Japan
| | - Ken Nakajima
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Toshiya Tokui
- Department of Thoracic Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Kensuke Oue
- Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Toru Mizumoto
- Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
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16
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Ghaffarian AA, Unangst J, Bartek MA, Newhall K, Kang PC, Shalhub S, Sweet MP. Sarcopenia predicts for long-term survival in patients with thoracoabdominal aortic aneurysms undergoing operative and nonoperative management. J Vasc Surg 2021; 75:343-347.e1. [PMID: 34506897 DOI: 10.1016/j.jvs.2021.08.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/10/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Sarcopenia, defined as a loss of muscle mass or poor muscle quality, is a syndrome associated with poor surgical outcomes. The prognostic value of sarcopenia in patients with thoracoabdominal aortic aneurysms (TAAAs) is unknown. The present study was designed to define sarcopenia in this patient population and assess its impact on survival among patients who had undergone operative and nonoperative management of TAAAs. METHODS We retrospectively reviewed all patients with a diagnosis of a TAAA at an academic hospital between 2009 and 2017 who had been selected for operative and nonoperative management. Sarcopenia was identified by measuring the total muscle area on a single axial computed tomography image at the third lumbar vertebra. The muscle areas were normalized by patient height, and cutoff values for sarcopenia were established at the lowest tertile of the normalized total muscle area. Long-term patient survival was assessed using Kaplan-Meier and Cox regression models. RESULTS A total of 295 patients were identified, of whom 199 had undergone operative management and 96 nonoperative management for TAAAs. The patients selected for nonoperative management were more likely to be women and to have chronic kidney disease, coronary artery disease, cerebrovascular disease, a higher modified frailty index, and a larger aortic diameter. The Kaplan-Meier analyses revealed significantly lower long-term survival for the patients with and without sarcopenia in the operative and nonoperative groups. In Cox regression analyses, sarcopenia was a significant predictor of shorter survival for both operative (hazard ratio, 0.96; 95% confidence interval, 0.94-0.99; P = .006) and nonoperative (hazard ratio, 0.95; 95% confidence interval, 0.90-1.00; P = .05) groups after adjusting for age, race, sex, maximum aortic diameter, modified frailty index, chronic kidney disease, and active smoking. Additionally, age was a significant predictor of shorter survival in the operative group, and smoking and aortic diameter were significant in the nonoperative group. CONCLUSIONS In our cohort of patients who had received operative and nonoperative management of TAAAs, the patients with sarcopenia had had significantly lower long-term survival, regardless of whether surgery had been performed. These data suggest that sarcopenia could be used as a predictor of survival for patients with TAAAs and might be useful for risk stratification and decision making in the management of TAAAs.
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Affiliation(s)
- Amir A Ghaffarian
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Jaryd Unangst
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Matthew A Bartek
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Karina Newhall
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - P Chuhli Kang
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
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Sakuyama A, Saitoh M, Iwai K, Kon K, Hori K, Nagayama M. Psoas Muscle Volume and Attenuation are Better Predictors than Muscle Area for Hospital Readmission in Older Patients after Transcatheter Aortic Valve Implantation. Phys Ther Res 2021; 24:128-135. [PMID: 34532208 DOI: 10.1298/ptr.e10079] [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: 10/16/2020] [Accepted: 11/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to determine whether the psoas muscle volume (PMV) and its muscle attenuation (MA) are associated with hospital readmission after transcatheter aortic valve implantation (TAVI). METHOD We included 113 older patients with aortic stenosis who underwent TAVI at Sakakibara Heart Institute (mean age 85 ± 5 years, 69% women). We measured PMV and psoas muscle area (PMA) as well as total muscle area (TMA) at the third lumbar vertebra using preoperative computed tomography (CT) images. The crude values of the PMV, PMA, and TMA were normalized by dividing by height squared. RESULTS The median follow-up period was 724 days (interquartile range: 528-730 days), and there were 25 all-cause readmissions during the follow-up period (22% of all patients). In the multivariate Cox regression analysis adjusted for age, sex, and EuroSCORE II, the PMV and its MA and crude PMA were significantly associated with all-cause readmission [HR: 0.957 (0.930-0.985), p = 0.003, HR: 0.927 (0.862-0.997), p = 0.040], whereas the PMA and TMA and each MA were not (all p > 0.05). The groups with low PMV and MA had significantly higher incidences of all-cause readmission than that with high PMV and MA (log-rank test: p = 0.011). CONCLUSION PMV and its MA measured from preoperative CT images were independent predictors of all-cause readmission in TAVI patients.
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Affiliation(s)
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Japan
| | - Keigo Iwai
- Department of Rehabilitation, Sakakibara Heart Institute, Japan
| | - Kazuki Kon
- Department of Rehabilitation, Sakakibara Heart Institute, Japan
| | - Kentaro Hori
- Department of Rehabilitation, Sakakibara Heart Institute, Japan
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18
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Preoperative sarcopenia and malnutrition are correlated with poor long-term survival after endovascular abdominal aortic aneurysm repair. Surg Today 2021; 52:98-105. [PMID: 34477979 DOI: 10.1007/s00595-021-02362-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sarcopenia and malnutrition are often used as surrogates for frailty, which is predictive of poor prognosis after surgery. We investigated the effects of sarcopenia and malnutrition on mortality after endovascular aneurysm repair (EVAR). METHODS The subjects of this study were patients who underwent EVAR at our hospital between June 2007 and December 2013, excluding those who underwent reintervention. The psoas muscle area at the L4 level was used as an indicator of sarcopenia. The Geriatric Nutritional Risk Index was used as an indicator of malnutrition. RESULTS There were 324 patients included in the study, with a mean age of 78.1 years and a median follow-up period of 56.7 months. Multivariate analysis revealed that sarcopenia (HR, 1.79; p = .042) and malnutrition (HR, 1.78; p = .043) were independent prognostic factors. Patients with both factors were classified as the high-risk group and others were classified as the low-risk group. The survival rate was significantly lower in the high-risk group than in the low-risk groups (p < .001). Even after propensity score matching, the high-risk group had a significantly lower survival rate (p < .001). CONCLUSION Both sarcopenia and malnutrition were associated with long-term mortality after EVAR. Patients with both indicators had a poor mid-term survival.
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19
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Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis. Nutrients 2021; 13:nu13072212. [PMID: 34199110 PMCID: PMC8308481 DOI: 10.3390/nu13072212] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation.
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Nadeswaran P, Ding L, Singh N, Plotkin A, Magee GA, Han SM, Garg PK. Functional performance status and risk of cardiovascular events and mortality following endovascular repair of thoracic and abdominal aortic pathology. Vascular 2021; 30:206-216. [PMID: 33900842 DOI: 10.1177/17085381211010545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize the association of preoperative functional performance status based on Eastern Cooperative Oncology Group (ECOG) scoring with the risk of adverse cardiovascular events, vascular events, and mortality in patients undergoing EVAR and TEVAR. METHODS Retrospective review of the Society for Vascular Surgery Vascular Quality Initiative, a large, multi-center, registry database was performed. All individuals undergoing EVAR (n = 18,730) and TEVAR (n = 6595) for non-ruptured aortic pathologies between 2014 and 2018 were eligible for analysis. Multivariable logistic regression was used to determine the association of pre-procedure ECOG functional performance status on risk of in-hospital adverse cardiovascular events, vascular events, and mortality. RESULTS The number of operations complicated by adverse cardiovascular and vascular events was 480 (2.6%) and 190 (1.0%) for EVAR and 733 (11.1%) and 219 (3.3%) for TEVAR, respectively. There were 118 (0.6%) and 240 (3.6%) in-hospital deaths following EVAR and TEVAR, respectively. Patients with ECOG grades 3 or 4 undergoing EVAR were at increased risk of cardiovascular events (OR = 1.62; 95% CI = 1.09, 2.41) and one-year mortality (HR = 2.62; 95% CI = 1.92, 3.57) compared to those with ECOG grade 0. Patients undergoing TEVAR with ECOG grade 3 or 4 were at increased risk for both inpatient death (OR = 2.77; 95% CI = 1.56, 4.9) and one-year mortality (HR = 3.27, 95% CI = 2.06, 5.21). ECOG status was not associated with an increased risk of adverse vascular events following either EVAR or TEVAR. CONCLUSIONS Poor preoperative functional status as assessed by ECOG score is associated with an increased risk of adverse postoperative cardiovascular events following EVAR and a higher mortality risk following both EVAR and TEVAR. Functional status assessment may be useful for risk stratification and determining procedural candidacy prior to EVAR and TEVAR.
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Affiliation(s)
- Pradeep Nadeswaran
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Li Ding
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Nikhil Singh
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sukgu M Han
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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21
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Maddox SS, Palines PA, Hoffman RD, Danos DM, Womac DJ, Tuggle CT, Stalder MW. A Novel Technique for Radiographic Diagnosis of Sarcopenia that Accurately Predicts Postoperative Complications in Lower Extremity Free Flap Patients. J Reconstr Microsurg 2021; 37:744-752. [PMID: 33853127 DOI: 10.1055/s-0041-1726396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel ("ellipse method"). METHODS A retrospective cohort study of 50 patients receiving free flap-based reconstruction of the LE was performed. Bilateral psoas density and area were quantified at L4 through tracing ("traditional method") and encircling ("ellipse method") to calculate Hounsfield unit average calculation (HUAC). Logistic regression and receiving operator curve analysis for the primary outcome of any postoperative complication was used to determine HUAC cutoffs (≤ 20.7 vs. ≤ 20.6) for sarcopenia. Risk of complications associated with sarcopenia was evaluated using Fisher's exact tests. RESULTS Twelve patients (24%) met criteria for sarcopenia via the traditional method and 16 (32%) via the ellipse method. By both methods, sarcopenic patients were older and more often female and diabetic. These patients also had higher American Society of Anesthesiologists scores and lower serum prealbumin levels. The ellipse method was found to be more accurate, sensitive, and specific than the traditional method in predicting postoperative morbidity (p = 0.009). Via the ellipse method, sarcopenic patients were at higher risk for any complication (p = 0.002) and were at a higher risk for a deep vein thrombus or pulmonary embolism via the traditional method (p = 0.047). CONCLUSION Sarcopenia is associated with greater pre- and postoperative morbidity in LE reconstruction. The novel ellipse method is a simplified and accurate method of assessing sarcopenia that can be easily performed in the clinical setting.
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Affiliation(s)
- Suma S Maddox
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Patrick A Palines
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Ryan D Hoffman
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Denise M Danos
- Department of Behavioral and Community Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Daniel J Womac
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.,University Medical Center-LCMC Health, New Orleans, Louisiana
| | - Charles T Tuggle
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.,University Medical Center-LCMC Health, New Orleans, Louisiana
| | - Mark W Stalder
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.,University Medical Center-LCMC Health, New Orleans, Louisiana
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22
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Xi F, Tan S, Gao T, Ding W, Sun J, Wei C, Li W, Yu W. Low skeletal muscle mass predicts poor clinical outcomes in patients with abdominal trauma. Nutrition 2021; 89:111229. [PMID: 33887547 DOI: 10.1016/j.nut.2021.111229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma. METHODS Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed. RESULTS Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm2/m2 for men and 37.35 cm2/m2 for women). Low skeletal muscle mass was significantly associated with longer hospital length of stay, longer intensive care length of stay, higher cost, higher frequency of mechanical ventilation, longer duration of vasopressor use, and higher incidence of massive transfusion and overall complications (P < 0.05). Subgroup analysis showed that pneumonia, acute gastrointestinal dysfunction, cholecystitis, digestive tract fistula, gastric fistula, and intestinal fistula were significantly associated with low skeletal muscle mass (P < 0.05). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for overall complications (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.33-4.49; P = 0.004), hospital length of stay (OR, 3.49; 95% CI, 1.96-6.20; P < 0.001), and hospital cost (OR, 2.67; 95% CI, 1.48-4.80; P = 0.001). CONCLUSIONS Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.
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Affiliation(s)
- Fengchan Xi
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Gao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiwei Ding
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Jianfeng Sun
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Caiyun Wei
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiqin Li
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Wenkui Yu
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
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23
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Rozynek M, Kucybała I, Urbanik A, Wojciechowski W. Use of artificial intelligence in the imaging of sarcopenia: A narrative review of current status and perspectives. Nutrition 2021; 89:111227. [PMID: 33930789 DOI: 10.1016/j.nut.2021.111227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 01/10/2023]
Abstract
Sarcopenia is a muscle disease which previously was associated only with aging, but in recent days it has been gaining more attention for its predictive value in a vast range of conditions and its potential link with overall health. Up to this point, evaluating sarcopenia with imaging methods has been time-consuming and dependent on the skills of the physician. The solution for this problem may be found in artificial intelligence, which may assist radiologists in repetitive tasks such as muscle segmentation and body-composition analysis. The major aim of this review was to find and present the current status and future perspectives of artificial intelligence in the imaging of sarcopenia. We searched the PubMed database to find articles concerning the use of artificial intelligence in diagnostic imaging and especially in body-composition analysis in the context of sarcopenia. We found that artificial-intelligence systems could potentially help with evaluating sarcopenia and better predicting outcomes in a vast range of clinical situations, which could get us closer to the true era of precision medicine.
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Affiliation(s)
- Miłosz Rozynek
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Iwona Kucybała
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Andrzej Urbanik
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Wadim Wojciechowski
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland.
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24
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Alenezi AO, Tai E, Jaberi A, Brown A, Mafeld S, Roche-Nagle G. Adverse Outcomes after Advanced EVAR in Patients with Sarcopaenia. Cardiovasc Intervent Radiol 2021; 44:376-383. [PMID: 33388870 DOI: 10.1007/s00270-020-02721-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/19/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether low total psoas muscle area (tPMA), as a surrogate for sarcopaenia, is a predictor of adverse outcomes in patients undergoing advanced EVAR. MATERIALS AND METHODS A retrospective review of medical records was performed for 257 patients who underwent advanced EVAR (fenestrated or branched technique) in a single tertiary centre from 1 January 2008 to 1 September 2019. The study cohort was divided into tertiles based on tPMA measurement performed independently by two observers from a peri-procedural CT scan at the level of mid-L3 vertebral body. The low tertile was considered sarcopaenic. Logistic regression analysis was used to assess the association of tPMA with 30-day mortality and post-procedural complications. Univariable analysis and adjusted multivariable Cox regression were used to assess the association of tPMA with all-cause mortality. RESULTS A total of 257 patients comprised 193 males and 64 females with the mean age of 75.4 years (± 6.8) were included. Adjusted multivariable Cox regression revealed an 8% reduction in all-cause mortality for every 1 cm2 increase in tPMA, P < 0.05. TPMA was associated with 30-day mortality (OR 0.85, 95% CI 0.75-0.96, P < 0.05) and spinal cord ischaemia (SCI) (OR 0.89, 95% CI 0.82-0.97, P < 0.05). For remaining post-procedural complications, tPMA was not a useful predictive tool. TPMA correlated negatively with hospital stay length (rs-0.26, P < 0.001). Patients with lower tPMA were more likely to be discharged to a rehabilitation center (OR 0.93, 95% CI 0.87-0.98 , P < 0.05). CONCLUSION Measurement of tPMA can be a useful predictive tool for adverse outcomes after advanced EVAR. LEVEL OF EVIDENCE Level 3, Retrospective cohort study.
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Affiliation(s)
- Abdullah O Alenezi
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada.
| | - Elizabeth Tai
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | - Arash Jaberi
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | | | - Sebastian Mafeld
- Joint Department of Medical Imaging, University Health Network - Toronto General Hospital, Toronto, ON, Canada
| | - Graham Roche-Nagle
- Department of Vascular Surgery, University Health Network - Toronto General Hospital, Toronto, ON, Canada
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25
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Kurose S, Matsubara Y, Yoshino S, Nakayama K, Yamashita S, Morisaki K, Furuyama T, Mori M. Influence of Internal Iliac Artery Embolization during Endovascular Aortic Repair Regarding Postoperative Sarcopenia and Midterm Survival. Ann Vasc Surg 2020; 74:148-157. [PMID: 33248242 DOI: 10.1016/j.avsg.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/28/2020] [Accepted: 10/10/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative sarcopenia is a risk factor for postoperative mortality. Internal iliac artery embolization (IIAE) during endovascular aortic repair (EVAR) has ischemic effects on pelvic skeletal muscles because IIAE causes buttock claudication. The long-term effects of IIAE on pelvic skeletal muscle, however, have not been well investigated. We hypothesized that IIAE after EVAR induces a decrease in skeletal muscle, which leads to postoperative sarcopenia. MATERIALS AND METHODS Patients with abdominal aortic aneurysms who underwent EVAR from 2009 to 2014 were retrospectively reviewed. Skeletal muscle areas (SMAs) at the third lumbar level and the mid-femoral level were measured on transverse computed tomographic images. Postoperative sarcopenia was defined as a >10% decrease in the L3 SMA as established in a previous study. We assessed the association between postoperative sarcopenia and IIAE. RESULTS Altogether, 102 eligible patients who underwent elective EVAR comprised the study group. The L3 SMA at the 3-year follow-up evaluation was significantly smaller in patients with than without IIAE (P < 0.05). The SMAs of the psoas, lumbar, and thigh muscles were significantly smaller on the IIAE than non-IIAE side (P < 0.05). IIAE was thus revealed as an independent risk factor for postoperative sarcopenia (hazard ratio, 4.69; P = 0.008). In addition, patients who developed postoperative sarcopenia had a lower overall survival rate than those without postoperative sarcopenia (P < 0.001). CONCLUSIONS IIAE during EVAR is a risk factor for postoperative sarcopenia, which is in turn associated with mortality. Hence, we should preserve the internal iliac artery whenever possible. Alternatively, if IIAE is deemed necessary, we should postoperatively institute protocols to prevent sarcopenia from developing.
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Affiliation(s)
- Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Vascular Biology and Therapeutics, School of Medicine, Yale University, New Haven, CT
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sho Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Kärkkäinen JM, Oderich GS, Tenorio ER, Pather K, Oksala N, Macedo TA, Vrtiska T, Mees B, Jacobs MJ. Psoas muscle area and attenuation are highly predictive of complications and mortality after complex endovascular aortic repair. J Vasc Surg 2020; 73:1178-1188.e1. [PMID: 33002587 DOI: 10.1016/j.jvs.2020.08.141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study evaluated the psoas muscle area and attenuation (radiodensity), quantified by computed tomography, together with clinical risk assessment, as predictors of outcomes after fenestrated and branched endovascular aortic repair (FBEVAR). METHODS The present single-center study included 504 patients who had undergone elective FBEVAR for pararenal or thoracoabdominal aortic aneurysms. The clinical risk assessment included age, sex, comorbidities, body mass index, glomerular filtration rate, aneurysm size and extent, cardiac stress test results, ejection fraction, and American Society of Anesthesiologists (ASA) score. Preoperative computed tomography was used to measure the psoas muscle area and attenuation at the L3 level. The lean psoas muscle area (LPMA; area in cm2 multiplied by attenuation in Hounsfield units [HU]) was calculated by multiplying the area by the attenuation. The risk factors for 90-day mortality, major adverse events (MAEs), and long-term mortality were determined using multivariable analysis. MAEs included 30-day or in-hospital death, acute kidney injury, myocardial infarction, respiratory failure, paraplegia, stroke, and bowel ischemia. A novel risk stratification method was proposed according to the strongest predictors of mortality and MAEs on multivariable analysis. RESULTS The 30-day mortality, 90-day mortality, and MAE rates were 2.0%, 5.6%, and 20%, respectively. The independent predictors of 90-day mortality were chronic obstructive pulmonary disease, chronic kidney disease, ASA score, and LPMA. The independent predictors of MAEs were aneurysm diameter, glomerular filtration rate, and LPMA. For long-term mortality, the independent predictors were chronic kidney disease, congestive heart failure, extent I-III thoracoabdominal aortic aneurysms, ASA score, and LPMA. The patients were stratified into three groups according to the ASA score and LPMA: low risk, ASA score II or LPMA >350 cm2HU (n = 290); medium risk, ASA score III and LPMA ≤350 cm2HU (n = 181); and high risk, ASA score IV and LPMA ≤350 cm2HU (n = 33). The 90-day mortality and MAE rates were 1.7% and 16% in the low-, 7.2% and 24% in the medium-, and 30% and 33% in the high-risk patients, respectively (P < .001 and P = .02, respectively). Patients with ASA score IV and LPMA <200 cm2HU, indicating sarcopenia (n = 14) had a 43% risk of death within 90 days. The 3-year survival estimates were 80% ± 3% for the low-, 70% ± 4% for the medium-, and 35% ± 9% for the high-risk patients (P < .001). The mean follow-up time was 3.1 ± 2.3 years. CONCLUSIONS LPMA was a strong predictor of outcomes and the only independent predictor of both mortality and MAEs after FBEVAR. A high muscle mass was protective against complications, regardless of the ASA score. Risk stratification based on the ASA score and LPMA can be used to identify patients at excessively high operative risk.
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Affiliation(s)
- Jussi M Kärkkäinen
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex.
| | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex
| | - Keouna Pather
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Thanila A Macedo
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Terri Vrtiska
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Barend Mees
- Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany
| | - Michael J Jacobs
- Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, University Hospital Aachen, Aachen, Germany; Maastricht University Medical Center, Maastricht, The Netherlands
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27
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Ouchi K, Oki Y, Sakuma T, Ojiri H. Risk of Psoas Muscle Atrophy After Endovascular Aneurysm Repair Assessed by Cross-Sectional Psoas Muscle Area. Cardiovasc Intervent Radiol 2020; 43:981-986. [PMID: 32415332 DOI: 10.1007/s00270-020-02500-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/17/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE We evaluated possible association of decreased psoas muscle area (PMA) after endovascular aneurysm repair (EVAR) by measuring the area of muscle in computed tomographic (CT) images. MATERIALS AND METHODS We retrospectively reviewed CT images of 201 consecutive patients who underwent EVAR at our institution between April 1, 2015, and November 9, 2018, and compared them with images of 75 consecutive patients with no history of EVAR, who served as controls and underwent thoracic endovascular aortic repair (TEVAR) during the same period. We investigated EVAR and possible associated factors that might be potential predictors of decrease in PMA. RESULTS Those patients with a history of EVAR demonstrated significantly greater mean decrease in PMA than those with a history of TEVAR after the repair procedure (mean 6.25% (8.5); P < 0.001; odds ratio [OR], 3.63; 95% confidence interval [CI] 1.90-6.90). CONCLUSION Although EVAR is a less stressful procedure than other major abdominal surgeries, we identified it as an independent predictor of decreased area of the psoas muscle. Thus, our results might encourage post-procedural evaluation of frailty associated with psoas muscle function and prescription of appropriate rehabilitation interventions after EVAR to help prevent deterioration of patients' abilities.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Yohei Oki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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