Association of skeletal muscle index with postoperative acute kidney injury in living donor hepatectomy: A retrospective single-centre cohort study

Prognostic value of preoperative nutritional status for postoperative moderate to severe acute kidney injury among older patients undergoing coronary artery bypass graft surgery: a retrospective study based on the MIMIC-IV database

OBJECTIVE

To investigate the association between preoperative nutritional scores and moderate-to-severe acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery and the predictive significance of nutritional indices for moderate to severe AKI.

METHODS

This study retrospectively included older patients underwent CABG surgery from the Medical Information Mart for Intensive Care (MIMIC) database. Nutritional scores were calculated by the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI), respectively. Moderate-to-severe injury was determined by KDIGO criteria. Logistic regression, subgroup analysis, and restricted cubic splines were utilized to investigate the association. The predictive value was also assessed by the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI).

RESULTS

A total of 1,007 patients were retrospectively included, of which 100 (9.9%) and 380 (37.7%) had malnutrition calculated by GNRI and PNI scores. The incidence of moderate-to-severe AKI was 524 (52.0%). After adjustment for selected risk factors, worse nutritional scores were associated with a higher incidence of moderate-to-severe AKI (PGNRI<0.001; PPNI=0.001). Integrating these indices into different base models improves their performance, as manifested by significant improvements in AUCs and NRIs (p < 0.05).

CONCLUSION

Worse preoperative nutritional status was associated with an elevated risk of postoperative moderate-to-severe AKI. Integrating these indices into base models improve their predictive performance. These results highlight the importance of assessing nutritional status among older patients had CABG surgery.

Association between Sarcopenia and Survival in Patients Undergoing Gamma Knife Surgery for Brain Metastasis from Breast Cancer: A Retrospective Single-centre Cohort Study

AIMS

Many recent studies related to cancer surgery have reported that sarcopenia influences mortality in surgical patients. However, few comprehensive studies have examined the associations between sarcopenia and short- and long-term surgical outcomes of metastatic cancer, especially breast cancer with brain metastasis. In the present study, we investigated the association between sarcopenia and mortality in patients who underwent gamma knife radiosurgery (GKRS) for brain metastasis with breast cancer.

MATERIALS AND METHODS

This retrospective study analysed 157 patients who underwent GKRS for brain metastasis with breast cancer between January 2014 and December 2018. A Cox regression analysis was carried out to evaluate the association between sarcopenia and mortality at 90 days, 180 days, 1 year, 3 years and the overall period.

RESULTS

In the Cox regression analysis, sarcopenia was significantly associated with high 90-day mortality (adjusted hazard ratio 3.46, 95% confidence interval 1.24-9.67, P = 0.018), 180-day mortality (adjusted hazard ratio 2.67, 95% confidence interval 1.37-5.22, P = 0.004), 1-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.42-4.02, P = 0.001), 3-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.53-3.74, P < 0.001) and overall mortality (adjusted hazard ratio 2.11, 95% confidence interval 1.37-3.26, P < 0.001).

CONCLUSION

Sarcopenia could be a risk factor for short- and long-term mortality in patients undergoing GKRS for brain metastasis from breast cancer.

Sarcopenia as a predictor of outcome after transcatheter aortic valve implantation: protocol for systematic review and meta-analysis

INTRODUCTION

Sarcopenia represents a central biological substratum of frailty, which increases the incidence of adverse events and mortality after surgery for oesophageal cancer, gastrectomy and pancreatic surgery. Recently, sarcopenia has been suggested as a predictor of outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). However, since relevant data were variable, we aimed to perform a systematic review and meta-analysis of the current literature to evaluate sarcopenia as a predictor of post-TAVI outcomes.

METHODS AND ANALYSIS

Two investigators will conduct independent searches in PubMed, EMBASE, Web of Science, MEDLINE and the Cochrane Library, from database inception to October 2022. The search will not be limited by language or region. Eligible studies will include reports investigating post-TAVI outcomes in patients with sarcopenia, who are aged >18 years and diagnosed using a CT scan. The primary outcome is short-term mortality (30-day mortality), while the secondary outcomes include long-term mortality (>30 days), length of intensive care unit (ICU) stay, need for ICU admission (the number of patients in the sarcopenia or non-sarcopenia group requiring ICU admission), length of hospital stay and overall complications. Included studies will be assessed for risk of bias according to the Quality in Prognosis Studies critical assessment tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation. The analysis will be done with Review Manager (V.5.4) software. If testing reveals little or no statistical heterogeneity, a fixed-effect model will be used for data synthesis; otherwise, a random-effect model may be employed. On encountering substantial heterogeneity, subgroup analysis and leave-one-out jackknife sensitivity analysis will be used to verify the robustness of the results. The obtained results will be presented as forest plots while Cochran's Q test and I² test will be used to calculate the heterogeneity (>50% indicating strong heterogeneity).

ETHICS AND DISSEMINATION

No ethical approval is needed for this study since we will be using data from previously published studies. The results will be disseminated in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022349525.