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Koh JH, Tan LTP, Lim CYJ, Yuen LZH, Ho JSY, Tan JA, Sia CH, Yeo LLL, Koh FHX, Hallinan JTPD, Makmur A, Tan BYQ, Tan LF. Association of head and neck CT-derived sarcopenia with mortality and adverse outcomes: A systematic review. Arch Gerontol Geriatr 2024; 126:105549. [PMID: 38944005 DOI: 10.1016/j.archger.2024.105549] [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: 03/28/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND There is growing interest in the association of CT-assessed sarcopenia with adverse outcomes in non-oncological settings. PURPOSE The aim of this systematic review is to summarize existing literature on the prognostic implications of CT-assessed sarcopenia in non-oncological patients. MATERIALS AND METHODS Three independent authors searched Medline/PubMed, Embase and Cochrane Library up to 30 December 2023 for observational studies that reported the presence of sarcopenia defined on CT head and neck in association with mortality estimates and other adverse outcomes, in non-oncological patients. The quality of included studies were assessed using the Quality of Prognostic Studies tool. RESULTS Overall, 15 studies (3829 participants) were included. Nine studies were at low risk of bias, and six were at moderate risk of bias. Patient populations included those admitted for trauma or treatment of intracranial aneurysms, ischemic stroke, transient ischemic attack, and intracranial stenosis. Sarcopenia was associated with increased 30-day to 2-year mortality in inpatients and patients undergoing carotid endarterectomy or mechanical thrombectomy for acute ischemic stroke. Sarcopenia was also associated with poorer neurological and functional outcomes, increased likelihood of admission to long-term care facilities, and longer duration of hospital stays. The observed associations of sarcopenia with adverse outcomes remained similar across different imaging modalities and methods for quantifying sarcopenia. CONCLUSION CT-assessed sarcopenia was associated with increased mortality and poorer outcomes across diverse patient populations. Measurement and early identification of sarcopenia in vulnerable patients allows for enhanced prognostication, and focused allocation of resources to mitigate adverse outcomes.
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Affiliation(s)
- Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lucas Tze Peng Tan
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Claire Yi Jia Lim
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Linus Zhen Han Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Justina Angel Tan
- Division of Geriatric Medicine, Department of Medicine, Alexandra Hospital, Singapore
| | - Ching Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
| | | | | | | | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Li Feng Tan
- Department of Medicine, Alexandra Hospital, Singapore.
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Kregel HR, Hatton GE, Harvin JA, Puzio TJ, Wade CE, Kao LS. Identifying Age-Specific Risk Factors for Poor Outcomes After Trauma With Machine Learning. J Surg Res 2024; 296:465-471. [PMID: 38320366 DOI: 10.1016/j.jss.2023.12.016] [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: 02/17/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Risk stratification for poor outcomes is not currently age-specific. Risk stratification of older patients based on observational cohorts primarily composed of young patients may result in suboptimal clinical care and inaccurate quality benchmarking. We assessed two hypotheses. First, we hypothesized that risk factors for poor outcomes after trauma are age-dependent and, second, that the relative importance of various risk factors are also age-dependent. METHODS A cohort study of severely injured adult trauma patients admitted to the intensive care unit 2014-2018 was performed using trauma registry data. Random forest algorithms predicting poor outcomes (death or complication) were built and validated using three cohorts: (1) patients of all ages, (2) younger patients, and (3) older patients. Older patients were defined as aged 55 y or more to maintain consistency with prior trauma literature. Complications assessed included acute renal failure, acute respiratory distress syndrome, cardiac arrest, unplanned intubation, unplanned intensive care unit admission, and unplanned return to the operating room, as defined by the trauma quality improvement program. Mean decrease in model accuracy (MDA), if each variable was removed and scaled to a Z-score, was calculated. MDA change ≥4 standard deviations between age cohorts was considered significant. RESULTS Of 5489 patients, 25% were older. Poor outcomes occurred in 12% of younger and 33% of older patients. Head injury was the most important predictor of poor outcome in all cohorts. In the full cohort, age was the most important predictor of poor outcomes after head injury. Within age cohorts, the most important predictors of poor outcomes, after head injury, were surgery requirement in younger patients and arrival Glasgow Coma Scale in older patients. Compared to younger patients, head injury and arrival Glasgow Coma Scale had the greatest increase in importance for older patients, while systolic blood pressure had the greatest decrease in importance. CONCLUSIONS Supervised machine learning identified differences in risk factors and their relative associations with poor outcomes based on age. Age-specific models may improve hospital benchmarking and identify quality improvement targets for older trauma patients.
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Affiliation(s)
- Heather R Kregel
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas.
| | - Gabrielle E Hatton
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - John A Harvin
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Thaddeus J Puzio
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas
| | - Charles E Wade
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
| | - Lillian S Kao
- Division of Acute Care Surgery, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas; Center for Translational Injury, McGovern Medical School at UTHealth, Houston, Texas
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Tanabe C, Reed MJ, Pham TN, Penn K, Bentov I, Kaplan SJ. Association of Brain Atrophy and Masseter Sarcopenia With 1-Year Mortality in Older Trauma Patients. JAMA Surg 2019; 154:716-723. [PMID: 31066880 PMCID: PMC6506900 DOI: 10.1001/jamasurg.2019.0988] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/19/2019] [Indexed: 12/11/2022]
Abstract
Importance Older adults are disproportionately affected by trauma and accounted for 47% of trauma fatalities in 2016. In many populations and disease processes, described risk factors for poor clinical outcomes include sarcopenia and brain atrophy, but these remain to be fully characterized in older trauma patients. Sarcopenia and brain atrophy may be opportunistically evaluated via head computed tomography, which is often performed during the initial trauma evaluation. Objective To investigate the association of masseter sarcopenia and brain atrophy with 1-year mortality among trauma patients older than 65 years by using opportunistic computed tomography imaging. Design, Setting, and Participants This retrospective cohort study was conducted in a level 1 trauma center from January 1, 2011, to December 31, 2014, with a 1-year follow-up to assess mortality. Washington state residents 65 years or older who were admitted to the trauma intensive care unit with a head Abbreviated Injury Scale score of less than 3 were eligible. Patients with incomplete data and death within 1 day of admission were excluded. Data analysis was completed from June 2017 to October 2018. Exposures Masseter muscle cross-sectional area and brain atrophy index were measured using a standard clinical Picture Archiving and Communication System application to assess for sarcopenia and brain atrophy, respectively. Main Outcomes and Measures Primary outcome was 1-year mortality. Secondary outcomes were discharge disposition and 30-day mortality. Results The study cohort included 327 patients; 72 (22.0%) had sarcopenia only, 71 (21.7%) had brain atrophy only, 92 (28.1%) had both, and 92 (28.1%) had neither. The mean (SD) age was 77.8 (8.6) years, and 159 patients (48.6%) were women. After adjustment for age, comorbidity, complications, and injury characteristics, masseter sarcopenia and brain atrophy were both independently and cumulatively associated with mortality (masseter muscle cross-sectional area per SD less than the mean: hazard ratio, 2.0 [95% CI, 1.2-3.1]; P = .005; brain atrophy index per SD greater than the mean: hazard ratio, 2.0 [95% CI, 1.1-3.5]; P = .02). Conclusions and Relevance Masseter muscle sarcopenia and brain atrophy were independently and cumulatively associated with 1-year mortality in older trauma patients after adjustment for other clinical factors. These radiologic indicators are easily measured opportunistically through standard imaging software. The results can potentially guide conversations regarding prognosis and interventions with patients and their families.
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Affiliation(s)
- Christopher Tanabe
- John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Honolulu
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - May J. Reed
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Tam N. Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle
| | - Kevin Penn
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Itay Bentov
- Department of Anesthesiology & Pain Medicine, University of Washington, Harborview Medical Center, Seattle
| | - Stephen J. Kaplan
- Division of Geriatrics and Gerontology, Department of Medicine, University of Washington, Harborview Medical Center, Seattle
- Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
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Seno S, Tomura S, Ono K, Tanaka Y, Ikeuchi H, Saitoh D. Poor prognostic factors in elderly patients aged 75 years old or older with mild traumatic brain injury. J Clin Neurosci 2019; 67:124-128. [PMID: 31221574 DOI: 10.1016/j.jocn.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
The incidence of traumatic brain injury (TBI) in elderly patients is increasing. We retrospectively investigated the poor prognostic factors at discharge in elderly patients aged 75 years or older admitted to hospital with mild TBI. We continuously enrolled 83 patients aged 75 years or older with mild TBI, in a private general Japanese hospital. The Glasgow Coma Scale scores on admission were within the range of 13-15. Patients with good recovery or moderate disability were included in the "good outcome" group, and those with severe disability, in a persistent vegetative state, or who died were included in the "poor outcome" group. We performed statistical analyses using 8 parameters. We conducted a univariate analysis on each item. Next, we conducted a logistic regression analysis on variables where the p < 0.20 in the univariate analysis. Elderly patients had a poor prognosis when they had dementia (odds ratio [OR]: 20.357, 95% confidence interval [CI]: 2.075-199.683, p = 0.010), cancer (OR: 14.005, 95% CI: 1.262-154.444, p = 0.032), or a history of antithrombotic therapy before admission (OR: 6.673, 95% CI: 1.072-41.526, p = 0.042). When elderly patients aged 75 years or older with mild TBI have the 3 poor prognostic factors of dementia, cancer, or a history of antithrombotic therapy, their outcomes might be worse compared to other elderly patients. Elderly patients who have these factors should be carefully managed.
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Affiliation(s)
- Soichiro Seno
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan; Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan.
| | - Satoshi Tomura
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Kenichiro Ono
- Department of Neurosurgery, Mishuku Hospital, Tokyo, Japan
| | - Yoshihiro Tanaka
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Hisashi Ikeuchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan; Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
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Çakır T, Kayacı S, Aydın MD, Özöner B, Çalık İ, Altınkaynak K. A New Neuropathologic Mechanism of Blood pH Irregularities After Neck Trauma: Importance of Carotid Body-Glossopharyngeal Nerve Network Degeneration. World Neurosurg 2019; 125:e972-e977. [PMID: 30763747 DOI: 10.1016/j.wneu.2019.01.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We created a neck trauma model by injecting blood into the sheath of rabbits' carotid bodies (CBs). Then we determined the relationship between neuronal degeneration of the CB due to hemorrhage of this organ and its clinical effects such as blood pH and heart rhythm. METHODS The present study included 24 adult male New Zealand rabbits. The animals were divided into 3 groups: control (n = 5); sham (0.5 mL saline injected into CBs; n = 5); and study (CB trauma model; n = 14). pH values and heart rhythms were recorded before the experiment to determine the values under normal conditions, and measurements were repeated thrice in the days following the experiment. The number of normal and degenerated neuron density of CBs was counted. The relationship between the blood pH values, heart rhythms, and degenerated neuron densities was analyzed. RESULTS Heart rhythms were 218 ± 20 in the control group, 197 ± 16 in the sham group (P = 0.09), and 167 ± 13 in the study group (P < 0.0005). pH values were 7.40 ± 0.041 in the control group, 7.321 ± 0.062 in the sham group (P = 0.203), and 7.23 ± 0.02 in study group (P < 0.0005). Degenerated neuron densities were 12 ± 4/mm3 in the control group, 430 ± 74/mm3 in the sham group (P < 0.005), and 7434 ± 810/mm3 in the study group (P < 0.0001). CONCLUSIONS A high degenerate neuron density in the CB can decrease blood pH and hearth rhythm after neck trauma, and there might be a close relationship between the number of degenerated neurons and clinical findings (such as heart rhythm and blood pH). This relationship suggests that injury to the glossopharyngeal nerve-CB network can cause acidosis by disturbing the breathing-circulating reflex and results in respiratory acidosis.
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Affiliation(s)
- Tayfun Çakır
- Department of Neurosurgery, Medical Faculty of Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Selim Kayacı
- Department of Neurosurgery, Medical Faculty of Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Mehmet Dumlu Aydın
- Department of Neurosurgery, Medical Faculty of Ataturk University, Turkey.
| | - Barış Özöner
- Department of Neurosurgery, Medical Faculty of Erzincan Binali Yildirim University, Erzincan, Turkey
| | - İlknur Çalık
- Department of Pathology, Medical Faculty of Fırat University, Elazığ, Turkey
| | - Konca Altınkaynak
- Department of Biochemistry, Erzurum Research-Training Hospital, Erzurum, Turkey
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