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Rodriguez C, Mota JD, Palmer TB, Heymsfield SB, Tinsley GM. Skeletal muscle estimation: A review of techniques and their applications. Clin Physiol Funct Imaging 2024; 44:261-284. [PMID: 38426639 DOI: 10.1111/cpf.12874] [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: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
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Affiliation(s)
- Christian Rodriguez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Jacob D Mota
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Ty B Palmer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Steven B Heymsfield
- Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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Ahn S, Jin BY, Park JH, Kim S, Lee S, Moon S, Cho H. Thigh muscle mass evaluated by point-of-care ultrasound is associated with short-term mortality in patients with sepsis in the emergency department. Sci Rep 2024; 14:12776. [PMID: 38834760 PMCID: PMC11150469 DOI: 10.1038/s41598-024-63769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 05/31/2024] [Indexed: 06/06/2024] Open
Abstract
Muscle mass depletion is associated with mortality and morbidity in various conditions including sepsis. However, few studies have evaluated muscle mass using point-of-care ultrasound in patients with sepsis. This study aimed to evaluate the association between thigh muscle mass, evaluated using point-of-care ultrasound with panoramic view in patients with sepsis in the emergency department, and mortality. From March 2021 to October 2022, this prospective observational study used sepsis registry. Adult patients who were diagnosed with sepsis at the emergency department and who underwent point-of-care ultrasounds for lower extremities were included. The thigh muscle mass was evaluated by the cross-sectional area of the quadriceps femoris (CSA-QF) on point-of-care ultrasound using panoramic view. The primary outcome was 28 day mortality. Multivariable Cox proportional hazard model was performed. Of 112 included patients with sepsis, mean CSA-QF was significantly lower in the non-surviving group than surviving group (49.6 [34.3-56.5] vs. 63.2 [46.9-79.6] cm2, p = 0.002). Each cm2 increase of mean CSA-QF was independently associated with decreased 28 day mortality (adjusted hazard ratio 0.961, 95% CI 0.928-0.995, p = 0.026) after adjustment for potential confounders. The result of other measurements of CSA-QF were similar. The muscle mass of the quadriceps femoris evaluated using point-of-care ultrasound with panoramic view was associated with mortality in patients with sepsis. It might be a promising tool for determining risk factors for mortality in sepsis patients in the early stages of emergency department.
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Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Bo-Yeong Jin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, 15355, Republic of Korea.
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Galata C, Schiller P, Müller L, Karampinis I, Stamenovic D, Buhl R, Kreuter M, Roessner ED. Thoracic skeletal muscle mass predicts mortality in patients with surgery for pleural empyema: A case control study. Thorac Cancer 2024; 15:1201-1207. [PMID: 38597111 PMCID: PMC11128367 DOI: 10.1111/1759-7714.15307] [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: 01/17/2024] [Revised: 03/23/2024] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND This study investigated the role of the thoracic skeletal muscle mass as a marker of sarcopenia on postoperative mortality in pleural empyema. METHODS All consecutive patients (n = 103) undergoing surgery for pleural empyema in a single tertiary referral center between January 2020 and December 2022 were eligible for this study. Thoracic skeletal muscle mass index (TSMI) was determined from preoperative computed tomography scans. The impact of TSMI and other potential risk factors on postoperative in-hospital mortality was retrospectively analyzed. RESULTS A total of 97 patients were included in this study. The in-hospital mortality rate was 13.4%. In univariable analysis, low values for preoperative TSMI (p = 0.020), low preoperative levels of thrombocytes (p = 0.027) and total serum protein (p = 0.046) and higher preoperative American Society of Anesthesiologists (ASA) category (p = 0.007) were statistically significant risk factors for mortality. In multivariable analysis, only TSMI (p = 0.038, OR 0.933, 95% CI: 0.875-0.996) and low thrombocytes (p = 0.031, OR 0.944, 95% CI: 0.988-0.999) remained independent prognostic factors for mortality. CONCLUSIONS TSMI was a significant prognostic risk factor for postoperative mortality in patients with pleural empyema. TSMI may be suitable for risk stratification in this disease with high morbidity and mortality, which may have further implications for the selection of the best treatment strategy.
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Affiliation(s)
- Christian Galata
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
| | - Philipp Schiller
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
- Department of Surgery, RoMed Hospital RosenheimRosenheimGermany
| | - Lukas Müller
- Department of Radiology, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
| | - Ioannis Karampinis
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
| | - Davor Stamenovic
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
| | - Roland Buhl
- Department for Pulmonology, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
| | - Michael Kreuter
- Center for Pulmonary Medicine, Department for Pulmonology, Center for Thoracic DiseasesUniversity Medical Center Mainz, Critical Care & Sleep Medicine, Marienhaus Clinic MainzMainzGermany
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center MainzJohannes Gutenberg University MainzMainzGermany
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Nosiglia O, Cambón V, Filippi P, Ríos A, Romero Y, Vacca A, Gaiero C, Angulo M. Development of pectoral muscle atrophy in critically ill patients. Med Intensiva 2023; 47:350-353. [PMID: 36464581 DOI: 10.1016/j.medine.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/15/2022] [Accepted: 10/23/2022] [Indexed: 05/29/2023]
Affiliation(s)
- O Nosiglia
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - V Cambón
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - P Filippi
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - A Ríos
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Y Romero
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - A Vacca
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - C Gaiero
- Centro de Tratamiento Intensivo, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - M Angulo
- Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay; Laboratorio de Exploración Funcional Respiratoria, Centro de Tratamiento Intensivo, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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Herault A, Lévêque E, Draye-Carbonnier S, Decazes P, Zduniak A, Modzelewski R, Libraire J, Achamrah N, Ménard AL, Lenain P, Contentin N, Grall M, Leprêtre S, Lemasle E, Lanic H, Alani M, Stamatoullas-Bastard A, Tilly H, Jardin F, Tamion F, Camus V. High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock. Clin Nutr ESPEN 2023; 55:373-383. [PMID: 37202070 DOI: 10.1016/j.clnesp.2023.04.007] [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: 12/22/2022] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS We aimed to evaluate body composition (BC) by computed tomography (CT) in hematologic malignancy (HM) patients admitted to the intensive care unit (ICU) for sepsis or septic shock. METHODS We retrospectively assessed BC and its impact on outcome of 186 patients at the 3rd lumbar (L3) and 12th thoracic vertebral levels (T12) using CT-scan performed before ICU admission. RESULTS The median patient age was 58.0 [47; 69] years. Patients displayed adverse clinical characteristics at admission with median [q1; q3] SAPS II and SOFA scores of 52 [40; 66] and 8 [5; 12], respectively. The mortality rate in the ICU was 45.7%. Overall survival rates at 1 month after admission in the pre-existing sarcopenic vs. non pre-existing sarcopenic patients were 47.9% (95% CI [37.6; 61.0]) and 55.0% (95% CI [41.6; 72.8]), p = 0.99), respectively, at the L3 level and 48.4% (95% CI [40.4; 58.0]) vs. 66.7% (95% CI [51.1; 87.0]), p = 0.062), respectively, at the T12 level. CONCLUSIONS Sarcopenia is assessable by CT scan at both the T12 and L3 levels and is highly prevalent in HM patients admitted to the ICU for severe infections. Sarcopenia may contribute to the high mortality rate in the ICU in this population.
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Affiliation(s)
- Antoine Herault
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lévêque
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Centre Henri Becquerel, Rouen, France; Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Alexandra Zduniak
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Romain Modzelewski
- Unité QuantIF LITIS EA 4108, Université de Rouen, Normandie, France; Département D'imagerie, Centre Henri-Becquerel, Rouen, France
| | - Julie Libraire
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Najate Achamrah
- Department of Nutrition, Charles Nicolle University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Maximilien Grall
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Stéphane Leprêtre
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Hélène Lanic
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Mustafa Alani
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | | | - Hervé Tilly
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Fabienne Tamion
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France; Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, France
| | - Vincent Camus
- Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France.
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Yang H, Wan XX, Ma H, Li Z, Weng L, Xia Y, Zhang XM. Prevalence and mortality risk of low skeletal muscle mass in critically ill patients: an updated systematic review and meta-analysis. Front Nutr 2023; 10:1117558. [PMID: 37252244 PMCID: PMC10213681 DOI: 10.3389/fnut.2023.1117558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
Background Patients with critical illness often develop low skeletal muscle mass (LSMM) for multiple reasons. Numerous studies have explored the association between LSMM and mortality. The prevalence of LSMM and its association with mortality are unclear. This systematic review and meta-analysis was performed to examine the prevalence and mortality risk of LSMM among critically ill patients. Methods Three internet databases (Embase, PubMed, and Web of Science) were searched by two independent investigators to identify relevant studies. A random-effects model was used to pool the prevalence of LSMM and its association with mortality. The GRADE assessment tool was used to assess the overall quality of evidence. Results In total, 1,582 records were initially identified in our search, and 38 studies involving 6,891 patients were included in the final quantitative analysis. The pooled prevalence of LSMM was 51.0% [95% confidence interval (CI), 44.5-57.5%]. The subgroup analysis showed that the prevalence of LSMM in patients with and without mechanical ventilation was 53.4% (95% CI, 43.2-63.6%) and 48.9% (95% CI, 39.7-58.1%), respectively (P-value for difference = 0.44). The pooled results showed that critically ill patients with LSMM had a higher risk of mortality than those without LSMM, with a pooled odds ratio of 2.35 (95% CI, 1.91-2.89). The subgroup analysis based on the muscle mass assessment tool showed that critically ill patients with LSMM had a higher risk of mortality than those with normal skeletal muscle mass regardless of the different assessment tools used. In addition, the association between LSMM and mortality was statistically significant, independent of the different types of mortality. Conclusion Our study revealed that critically ill patients had a high prevalence of LSMM and that critically ill patients with LSMM had a higher risk of mortality than those without LSMM. However, large-scale and high-quality prospective cohort studies, especially those based on muscle ultrasound, are required to validate these findings. Systematic review registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022379200.
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Affiliation(s)
- Hui Yang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xi-Xi Wan
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Hui Ma
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Zhen Li
- Department of Urology, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Li Weng
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Ying Xia
- Department of Medical Intensive Care Unit, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Ming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College Hospital, Beijing, China
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Brunker LB, Boncyk CS, Rengel KF, Hughes CG. Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges. Clin Interv Aging 2023; 18:93-112. [PMID: 36714685 PMCID: PMC9879046 DOI: 10.2147/cia.s365968] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 01/23/2023] Open
Abstract
There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
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Affiliation(s)
- Lucille B Brunker
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina S Boncyk
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly F Rengel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher G Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Jiang T, Lin T, Shu X, Song Q, Dai M, Zhao Y, Huang L, Tu X, Yue J. Prevalence and prognostic value of preexisting sarcopenia in patients with mechanical ventilation: a systematic review and meta-analysis. Crit Care 2022; 26:140. [PMID: 35578299 PMCID: PMC9109453 DOI: 10.1186/s13054-022-04015-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/09/2022] [Indexed: 02/08/2023] Open
Abstract
Background Sarcopenia is defined as age-related loss of muscle mass, strength, and/or function in the context of aging. Mechanical ventilation (MV) is one of the most frequently used critical care technologies in critically ill patients. The prevalence of preexisting sarcopenia and the clinical impact of its prognostic value on patients with MV are unclear. This review sought to identify the prevalence and prognostic value of preexisting sarcopenia on MV patient health outcomes. Methods Relevant studies were identified by searching MEDLINE, Embase, and the Cochrane library and were searched for all articles published as of December 2021. The prevalence of sarcopenia was determined using the authors' definitions from the original studies. Comparisons were made between patients who did and did not have sarcopenia for prognostic outcomes, including mortality, the number of days of MV, the length of intensive care unit stay, and the length of hospital stay. Odds ratios (ORs) and weighted mean differences with 95% confidence intervals (CIs) were used for pooled analyses of the relationships between sarcopenia and prognostic outcomes. Results The initial search identified 1333 studies, 17 of which met the eligibility criteria for the quantitative analysis, including 3582 patients. The pooled prevalence was 43.0% (95% CI 34.0–51.0%; I2 = 96.7%). The pooled analyses showed that sarcopenia was related to increased mortality (OR 2.13; 95% CI 1.70, 2.67; I2 = 45.0%), longer duration of MV (MD = 1.22; 95% CI 0.39, 2.05; I2 = 97.0%), longer days of ICU stay (MD = 1.31; 95% CI 0.43, 2.19; I2 = 97.0%), and hospital stay (MD 2.73; 95% CI 0.58, 4.88; I2 = 98.0%) in patients with MV. Conclusion The prevalence of sarcopenia is relatively high in patients with MV, and it will have a negative impact on the prognosis of patients. However, further, large-scale, high-quality prospective cohort studies are required. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04015-y.
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Affiliation(s)
- Tingting Jiang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaoyu Shu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Miao Dai
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Li Huang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiangping Tu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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