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Takenoshita M, Weir McCall JR, Barker AP, Suresh S, Celik H, Vuylsteke A. Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support. Clin Radiol 2024; 79:272-278. [PMID: 38278741 DOI: 10.1016/j.crad.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
AIM To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. MATERIALS AND METHODS A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival. RESULTS The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047). CONCLUSIONS Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.
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Affiliation(s)
- M Takenoshita
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - J R Weir McCall
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK.
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - S Suresh
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - H Celik
- University of Massachusetts Chan Medical School, Massachusetts, USA
| | - A Vuylsteke
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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Kumagai H, Kim SJ, Miller B, Natsume T, Wan J, Kumagai ME, Ramirez R, Lee SH, Sato A, Mehta HH, Yen K, Cohen P. Mitochondrial-derived microprotein MOTS-c attenuates immobilization-induced skeletal muscle atrophy by suppressing lipid infiltration. Am J Physiol Endocrinol Metab 2024; 326:E207-E214. [PMID: 38170165 DOI: 10.1152/ajpendo.00285.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Mitochondrial open reading frame of the 12S ribosomal RNA type-c (MOTS-c), a mitochondrial microprotein, has been described as a novel regulator of glucose and lipid metabolism. In addition to its role as a metabolic regulator, MOTS-c prevents skeletal muscle atrophy in high fat-fed mice. Here, we examined the preventive effect of MOTS-c on skeletal muscle mass, using an immobilization-induced muscle atrophy model, and explored its underlying mechanisms. Male C57BL/6J mice (10 wk old) were randomly assigned to one of the three experimental groups: nonimmobilization control group (sterilized water injection), immobilization control group (sterilized water injection), and immobilization and MOTS-c-treated group (15 mg/kg/day MOTS-c injection). We used casting tape for the immobilization experiment. After 8 days of the experimental period, skeletal muscle samples were collected and used for Western blotting, RNA sequencing, and lipid and collagen assays. Immobilization reduced ∼15% of muscle mass, whereas MOTS-c treatment attenuated muscle loss, with only a 5% reduction. MOTS-c treatment also normalized phospho-AKT, phospho-FOXO1, and phospho-FOXO3a expression levels and reduced circulating inflammatory cytokines, such as interleukin-1b (IL-1β), interleukin-6 (IL-6), chemokine C-X-C motif ligand 1 (CXCL1), and monocyte chemoattractant protein 1 (MCP-1), in immobilized mice. Unbiased RNA sequencing and its downstream analyses demonstrated that MOTS-c modified adipogenesis-modulating gene expression within the peroxisome proliferator-activated receptor (PPAR) pathway. Supporting this observation, muscle fatty acid levels were lower in the MOTS-c-treated group than in the casted control mice. These results suggest that MOTS-c treatment inhibits skeletal muscle lipid infiltration by regulating adipogenesis-related genes and prevents immobilization-induced muscle atrophy.NEW & NOTEWORTHY MOTS-c, a mitochondrial microprotein, attenuates immobilization-induced skeletal muscle atrophy. MOTS-c treatment improves systemic inflammation and skeletal muscle AKT/FOXOs signaling pathways. Furthermore, unbiased RNA sequencing and subsequent assays revealed that MOTS-c prevents lipid infiltration in skeletal muscle. Since lipid accumulation is one of the common pathologies among other skeletal muscle atrophies induced by aging, obesity, cancer cachexia, and denervation, MOTS-c treatment could be effective in other muscle atrophy models as well.
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Affiliation(s)
- Hiroshi Kumagai
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
| | - Su-Jeong Kim
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Brendan Miller
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Toshiharu Natsume
- Graduate School of Health and Sports Science, Juntendo University, Chiba, Japan
- Faculty of Medicine, Tokai University, Kanagawa, Japan
| | - Junxiang Wan
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Michi Emma Kumagai
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Ricardo Ramirez
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Shin Hyung Lee
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Ayaka Sato
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Hemal H Mehta
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Kelvin Yen
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
| | - Pinchas Cohen
- The Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States
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Hajibandeh S, Hajibandeh S, Hughes I, Mitra K, Puthiyakunnel Saji A, Clayton A, Alessandri G, Duncan T, Cornish J, Morris C, O'Reilly D, Kumar N. Development and Validation of HAS (Hajibandeh Index, ASA Status, Sarcopenia) - A Novel Model for Predicting Mortality After Emergency Laparotomy. Ann Surg 2024; 279:501-509. [PMID: 37139796 DOI: 10.1097/sla.0000000000005897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To develop and validate a predictive model to predict the risk of postoperative mortality after emergency laparotomy taking into account the following variables: age, age ≥ 80, ASA status, clinical frailty score, sarcopenia, Hajibandeh Index (HI), bowel resection, and intraperitoneal contamination. SUMMARY BACKGROUND DATA The discriminative powers of the currently available predictive tools range between adequate and strong; none has demonstrated excellent discrimination yet. METHODS The TRIPOD and STROCSS statement standards were followed to protocol and conduct a retrospective cohort study of adult patients who underwent emergency laparotomy due to non-traumatic acute abdominal pathology between 2017 and 2022. Multivariable binary logistic regression analysis was used to develop and validate the model via two protocols (Protocol A and B). The model performance was evaluated in terms of discrimination (ROC curve analysis), calibration (calibration diagram and Hosmer-Lemeshow test), and classification (classification table). RESULTS One thousand forty-three patients were included (statistical power = 94%). Multivariable analysis kept HI (Protocol-A: P =0.0004; Protocol-B: P =0.0017), ASA status (Protocol-A: P =0.0068; Protocol-B: P =0.0007), and sarcopenia (Protocol-A: P <0.0001; Protocol-B: P <0.0001) as final predictors of 30-day postoperative mortality in both protocols; hence the model was called HAS (HI, ASA status, sarcopenia). The HAS demonstrated excellent discrimination (AUC: 0.96, P <0.0001), excellent calibration ( P <0.0001), and excellent classification (95%) via both protocols. CONCLUSIONS The HAS is the first model demonstrating excellent discrimination, calibration, and classification in predicting the risk of 30-day mortality following emergency laparotomy. The HAS model seems promising and is worth attention for external validation using the calculator provided. HAS mortality risk calculator https://app.airrange.io/#/element/xr3b_E6yLor9R2c8KXViSAeOSK .
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ioan Hughes
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Kalyan Mitra
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Amy Clayton
- Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - Giorgio Alessandri
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Trish Duncan
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Julie Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Chris Morris
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - David O'Reilly
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - Nagappan Kumar
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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Hajibandeh S, Hajibandeh S, Brown C, Harper ER, Saji AP, Hughes I, Mitra K, Rashwany H, Clayton A, Patel N, Abdelrahman T, Foliaki A, Kumar N. Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:59. [PMID: 38351404 DOI: 10.1007/s00423-024-03252-9] [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: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy METHODS: In compliance with STROCSS statement standards, a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. RESULTS A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs. 0.70, P<0.0001), in-hospital mortality (AUC: 0.79 vs. 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs. 0.67, P=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality [coefficient: 4.333, OR: 76.16 (95% CI 37.06-156.52), P<0.0001] but not the CFS [coefficient: 0.096, OR: 1.10 (95% CI 0.88-1.38), P=0.4047]. CONCLUSIONS Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Christopher Brown
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | | | | | - Ioan Hughes
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Kalyan Mitra
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Hind Rashwany
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Amy Clayton
- Department of Radiology, University Hospital of Wales, Cardiff, UK
| | - Neil Patel
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Tarig Abdelrahman
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Antonio Foliaki
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Nagappan Kumar
- Department of General Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Srinivas S, Villarreal ME, Baselice H, Bergus KC, Waterman B, Henderson K, Scarlet S, Young AJ, Helkin A. Identifying Factors Associated With Code Status Changes After Emergency General Surgery. J Surg Res 2024; 294:150-159. [PMID: 37890274 PMCID: PMC10841616 DOI: 10.1016/j.jss.2023.09.073] [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: 06/05/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Surgical emergencies are time sensitive. Identifying patients who may benefit from preoperative goals of care discussions is critical to ensuring that operative intervention aligns with the patient's values. We sought to identify patient factors associated with acute changes in a patient's goals using code status change (CSC) as proxy. METHODS A retrospective analysis of single-institution data for patients undergoing urgent laparotomy was performed. Patients were stratified based on whether a postoperative CSC occurred. Parametric, nonparametric, and regression analyses were used to identify variables associated with CSC. RESULTS Of 484 patients, 13.8% (n = 67) had a postoperative CSC. Patients with postoperative CSC were older (65 versus 60 years, P < 0.001). Odds of CSC were significantly higher in patients who were transferred between facilities (odds ratio [OR] 2.1), had a higher Charlson Comorbidity Index (3-4: OR 3.9, 5+: OR 6.8), and had a higher quick sequential organ failure assessment score (2: OR 5.0; 3: OR 38.7). Patients with anemia (OR 1.9) and active cancer (OR 3.0) had higher odds of CSC. CONCLUSIONS Timely intervention in emergency general surgery may result in high-risk interventions and subsequent complications that do not align with a patient's goals and values. Our analysis identified a subset of patients who undergo surgery and have a postoperative CSC leading to transition to comfort-focused care. In these patients, a pause in clinical momentum may help ensure operative intervention remains goal concordant.
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Affiliation(s)
- Shruthi Srinivas
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Michael E Villarreal
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Holly Baselice
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Katherine C Bergus
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brittany Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Sara Scarlet
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrew J Young
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alex Helkin
- Department of Trauma and Acute Care Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Swaab TDA, Quint EE, Westenberg LB, Zorgdrager M, Segev DL, McAdams‐DeMarco MA, Bakker SJL, Viddeleer AR, Pol RA. Validity of computed tomography defined body composition as a prognostic factor for functional outcome after kidney transplantation. J Cachexia Sarcopenia Muscle 2023; 14:2532-2539. [PMID: 37731200 PMCID: PMC10751408 DOI: 10.1002/jcsm.13316] [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: 09/30/2022] [Revised: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The prevalence of sarcopenia is markedly higher in kidney transplant candidates than in the general population. It is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, which increases the risk of adverse postoperative outcomes. METHODS We studied the impact of computed tomography defined preoperative sarcopenia, defined as a skeletal muscle index below age and gender specific cut-off values, on postoperative physical functional outcomes (grip strength, 4-m walking test, timed up and go, and sit to stand) at 6 months follow up. RESULTS A total of 107 patients transplanted between 2015 and 2019 were included in this single-centre study. Mean age was 60.3 (±13.1), and 68.2% of patients were male. Ten patients (9.4%) were identified as sarcopenic. Sarcopenic patients were younger (55.6 (±15.1) vs. 60.8 (±12.9) years), more likely to be female (60.0% vs. 28.9%), and had an increased dialysis vintage (19 [2.5-32.8] vs. 9 [0.0-21.0] months) in comparison with their non-sarcopenic counterparts. In univariate analysis, they had a significantly lower body mass index and skeletal muscle area (P ≤ 0.001). In multivariate regression analysis, skeletal muscle index was significantly associated with grip strength (β = 0.690, R2 = 0.232) and timed up and go performance (β = -0.070, R2 = 0.154). CONCLUSIONS We identified a significant association between sarcopenia existing pre-transplantation and poorer 6 months post-transplantation physical functioning with respect to hand grip strength and timed up and go tests in kidney transplant recipients. These results could be used to preoperatively identify patients with an increased risk of poor postoperative physical functional outcome, allowing for preoperative interventions to mitigate these risks.
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Affiliation(s)
- Tim D. A. Swaab
- Department of Surgery, Division of Transplantation Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Evelien E. Quint
- Department of Surgery, Division of Transplantation Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Lisa B. Westenberg
- Department of Surgery, Division of Transplantation Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Marcel Zorgdrager
- Department of Radiology, Medical Imaging CenterUniversity Medical Center GroningenGroningenThe Netherlands
| | - Dorry L. Segev
- Department of SurgeryNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Alain R. Viddeleer
- Department of Radiology, Medical Imaging CenterUniversity Medical Center GroningenGroningenThe Netherlands
| | - Robert A. Pol
- Department of Surgery, Division of Transplantation Surgery, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Tolonen A, Kerminen H, Lehtomäki K, Huhtala H, Bärlund M, Österlund P, Arponen O. Association between Computed Tomography-Determined Loss of Muscle Mass and Impaired Three-Month Survival in Frail Older Adults with Cancer. Cancers (Basel) 2023; 15:3398. [PMID: 37444508 DOI: 10.3390/cancers15133398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
As patients with solid (non-hematological) cancers and a life expectancy of <3 months rarely benefit from oncological treatment, we examined whether the CT-determined loss of muscle mass is associated with an impaired 3-month overall survival (OS) in frail ≥75-year-old patients with cancer. Frailty was assessed with G8-screening and comprehensive geriatric assessment in older adults at risk of frailty. The L3-level skeletal (SMI) and psoas (PMI) muscle indexes were determined from routine CT scans. Established and optimized SMI and PMI cut-offs were used. In the non-curative treatment group (n = 58), 3-month OS rates for normal and low SMI were 95% and 64% (HR 9.28; 95% CI 1.2-71) and for PMI 88%, and 60%, respectively (HR 4.10; 1.3-13). A Cox multivariable 3-month OS model showed an HR of 10.7 (1.0-110) for low SMI, 2.34 (0.6-9.8) for ECOG performance status 3-4, 2.11 (0.5-8.6) for clinical frailty scale 5-9, and 0.57 (0.1-2.8) for males. The 24-month OS rates in the curative intent group (n = 21) were 91% and 38% for the normal and low SMI groups, respectively. In conclusion, CT-determined low muscle mass is independently associated with an impaired 3-month OS and, alongside geriatric assessment, could aid in oncological versus best supportive care decision-making in frail patients with non-curable cancers.
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Affiliation(s)
- Antti Tolonen
- Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Hanna Kerminen
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Centre of Geriatrics, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
| | - Kaisa Lehtomäki
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Kalevantie 5, 33014 Tampere, Finland
| | - Maarit Bärlund
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
| | - Pia Österlund
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Teiskontie 35, 33520 Tampere, Finland
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Gastrointestinal Oncology, Tema Cancer, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
| | - Otso Arponen
- Department of Radiology, Tampere University Hospital, Kuntokatu 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön Katu 34, 33520 Tampere, Finland
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Yamaguchi K, Matsumoto S, Abe T, Nakajima K, Senoo S, Shimizu M, Takeuchi I. Predictive value of total psoas muscle index for postoperative physical functional decline in older patients undergoing emergency abdominal surgery. BMC Surg 2023; 23:171. [PMID: 37355574 DOI: 10.1186/s12893-023-02085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Older individuals increasingly require emergency abdominal surgeries. They are susceptible to surgical stress and loss of independence in performing daily activities. We hypothesized that the psoas muscle volume would be significantly associated with postoperative functional decline (FD) in older patients undergoing emergency abdominal surgery and aimed to evaluate the use of the psoas muscle volume on computed tomography (CT) scans. METHODS A retrospective, single-center study of patients aged ≥ 65 years who had undergone emergency abdominal surgery between January 2019 and June 2021 was performed. We assessed patients' activities of daily living using the Barthel Index. FD was defined as a ≥ 5-point decrease between preoperative and 28-day postoperative values. The psoas muscle volume was measured by CT, which was used for diagnosis, and normalized by height to calculate total psoas muscle index (TPI). We evaluated associations between FD and TPI using receiver operating characteristics (ROC) analysis and multiple logistic regression analysis. RESULTS Of 238 eligible patients, 71 (29.8%) had clinical postoperative FD. Compared to the non-FD group, the FD group was significantly older and had a higher proportion of females, higher Charlson Comorbidity Index, lower body mass index, higher American Society of Anesthesiology score, lower serum albumin level, and lower TPI. ROC analyses revealed that TPI had the highest area under the curve (0.802; 95% confidence interval [CI], 0.75-0.86). A multivariable logistic regression model revealed that low TPI was an independent predictor of postoperative FD (odds ratio, 0.14; 95% CI, 0.06-0.32). CONCLUSIONS TPI can predict postoperative FD due to emergency abdominal surgery. Identification of patients who are at high risk of FD before surgery may be useful for enhancing the regionalized system of care for emergency general surgery.
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Affiliation(s)
- Keishi Yamaguchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Shokei Matsumoto
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan.
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Kento Nakajima
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
| | - Satomi Senoo
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan
| | - Masayuki Shimizu
- Department of Trauma and Emergency Surgery, Saiseikai Yokohama-Shi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-Ku, Yokohama-Shi, Kanagawa, 230-0012, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-Ku, Yokohama-Shi, Kanagawa, 232-0024, Japan
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Affiliation(s)
- Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, Ctra. Colmenar Km 9100, 28034, Madrid, Spain.
| | - M Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
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Luo K, Yang L, Li Y. Sarcopenia as a predictor of outcome after transcatheter aortic valve implantation: protocol for systematic review and meta-analysis. BMJ Open 2022; 12:e067461. [PMID: 36450430 PMCID: PMC9717315 DOI: 10.1136/bmjopen-2022-067461] [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] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Kai Luo
- Department of Anesthesiology, Sichuan University, Chengdu, China
| | - Lei Yang
- Department of Anesthesiology, Sichuan University, Chengdu, China
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Cheng du, China
| | - Yu Li
- Department of Anesthesiology, Sichuan University, Chengdu, China
- Department of Anesthesiology, Chinese Academy of Medical Sciences, Cheng du, China
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Giakoumaki I, Pollock N, Aljuaid T, Sannicandro AJ, Alameddine M, Owen E, Myrtziou I, Ozanne SE, Kanakis I, Goljanek-Whysall K, Vasilaki A. Postnatal Protein Intake as a Determinant of Skeletal Muscle Structure and Function in Mice-A Pilot Study. Int J Mol Sci 2022; 23:8815. [PMID: 35955948 PMCID: PMC9369224 DOI: 10.3390/ijms23158815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
Sarcopenia is characterised by an age-related decrease in the number of muscle fibres and additional weakening of the remaining fibres, resulting in a reduction in muscle mass and function. Many studies associate poor maternal nutrition during gestation and/or lactation with altered skeletal muscle homeostasis in the offspring and the development of sarcopenia. The aim of this study was to determine whether the musculoskeletal physiology in offspring born to mouse dams fed a low-protein diet during pregnancy was altered and whether any physiological changes could be modulated by the nutritional protein content in early postnatal stages. Thy1-YFP female mice were fed ad libitum on either a normal (20%) or a low-protein (5%) diet. Newborn pups were cross-fostered to different lactating dams (maintained on a 20% or 5% diet) to generate three groups analysed at weaning (21 days): Normal-to-Normal (NN), Normal-to-Low (NL) and Low-to-Normal (LN). Further offspring were maintained ad libitum on the same diet as during lactation until 12 weeks of age, creating another three groups (NNN, NLL, LNN). Mice on a low protein diet postnatally (NL, NLL) exhibited a significant reduction in body and muscle weight persisting up to 12 weeks, unlike mice on a low protein diet only prenatally (LN, LNN). Muscle fibre size was reduced in mice from the NL but not LN group, showing recovery at 12 weeks of age. Muscle force was reduced in NLL mice, concomitant with changes in the NMJ site and changes in atrophy-related and myosin genes. In addition, μCT scans of mouse tibiae at 12 weeks of age revealed changes in bone mass and morphology, resulting in a higher bone mass in the NLL group than the control NNN group. Finally, changes in the expression of miR-133 in the muscle of NLL mice suggest a regulatory role for this microRNA in muscle development in response to postnatal diet changes. Overall, this data shows that a low maternal protein diet and early postnatal life low-protein intake in mice can impact skeletal muscle physiology and function in early life while postnatal low protein diet favours bone integrity in adulthood.
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Affiliation(s)
- Ifigeneia Giakoumaki
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Natalie Pollock
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- The MRC—Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool L7 8TX, UK
| | - Turki Aljuaid
- Department of Physiology, School of Medicine and REMEDI, CMNHS, NUI Galway, H91 TK33 Galway, Ireland
- Department of Biotechnology, College of Science, Taif University, Taif 21944, Saudi Arabia
| | - Anthony J. Sannicandro
- Department of Physiology, School of Medicine and REMEDI, CMNHS, NUI Galway, H91 TK33 Galway, Ireland
| | - Moussira Alameddine
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Euan Owen
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Ioanna Myrtziou
- Chester Medical School, University of Chester, Bache Hall, Countess View, Chester CH2 1BR, UK
| | - Susan E. Ozanne
- University of Cambridge MRC Metabolic Diseases Unit and Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke’s Hospital Cambridge, Cambridge CB2 0QQ, UK
| | - Ioannis Kanakis
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Chester Medical School, University of Chester, Bache Hall, Countess View, Chester CH2 1BR, UK
| | - Katarzyna Goljanek-Whysall
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- The MRC—Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool L7 8TX, UK
- Department of Physiology, School of Medicine and REMEDI, CMNHS, NUI Galway, H91 TK33 Galway, Ireland
| | - Aphrodite Vasilaki
- Department of Musculoskeletal & Ageing Science, Institute of Life Course & Medical Sciences, Faculty of Health & Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- The MRC—Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool L7 8TX, UK
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