Prevalence and prognostic value of preexisting sarcopenia in patients with mechanical ventilation: a systematic review and meta-analysis

Genetic overlap between breast cancer and sarcopenia: exploring the prognostic implications of SLC38A1 gene expression

BACKGROUND

Sarcopenia, an age-related syndrome characterized by a decline in muscle mass, not only affects patients' quality of life but may also increase the risk of breast cancer recurrence and reduce survival rates. Therefore, investigating the genetic mechanisms shared between breast cancer and sarcopenia is significant for the prevention, diagnosis, and treatment of breast cancer.

METHODS

This study downloaded gene expression datasets and clinical data related to breast cancer and skeletal muscle aging from the GEO database. Data preprocessing, integration, differential gene identification, functional enrichment analysis, and construction of protein-protein interaction networks were performed using R language. Subsequently, COX proportional hazards model analysis and survival analysis were conducted, and survival curves and nomograms were generated. The expression levels of genes in tissues were detected using qRT-PCR, and the Radiant DICOM viewer software was used to delineate the pectoralis major muscle area in CT images.

RESULTS

We identified 152 differentially expressed genes (P < .05) and 226 sarcopenia-related genes (r > .4) associated with skeletal muscle aging. The TCGA-BRCA dataset revealed 106 genes associated with breast cancer (P < .05, logFC = 1). Functional enrichment analysis indicated significant enrichment in cell proliferation and growth pathways. The PPI network identified critical molecules involved in muscle aging and tumor progression. After dimensionality reduction, a strong correlation was observed between the expression of the muscle aging-related gene set and the prognosis of breast cancer patients (P < .01). The expression of SLC38A1 identified through multivariate COX analysis was significantly associated with poor prognosis in breast cancer patients (P = .03). Incorporating SLC38A1 expression, the prognostic model precisely forecasted breast cancer survival (P < .01). External validation confirmed the higher expression of the SLC38A1 gene in breast cancer tissues compared to adjacent non-cancerous tissues (P < .01). The SLC38A1 index, calculated in combination with the patient's age and BMI, can optimize the prognostic prediction model, providing a powerful tool for personalized treatment of breast cancer.

CONCLUSION

High SLC38A1 gene expression was significantly associated with poor prognosis in breast cancer patients. The combination of SLC38A1 expression and the pectoralis major muscle area provided an optimized prognostic prediction model, offering a potential tool for personalized breast cancer treatment.

Association Between SARC-F and Clinical Outcomes in Older Adults With Cardiovascular Diseases Admitted to the Emergency Room: A Longitudinal Study

INTRODUCTION

Sarcopenia can be more significant and severe in the presence of cardiovascular diseases. In hospitalized older adults with acute cardiac disease, assessing strength parameters, muscle mass, and physical performance is difficult largely because of bed rest restrictions. In this context, simple questionnaire to rapidly diagnose sarcopenia (SARC-F) emerges as a feasible screening tool to identify sarcopenia in an emergency room setting.

OBJECTIVES

Assess the association between SARC-F, length of stay, mechanical ventilation, and in-hospital mortality in older adults with cardiovascular diseases admitted to the ER.

METHODOLOGY

An observational longitudinal study with 160 Brazilian older adults with cardiovascular diseases admitted to the hospital following an ER visit. The risk of sarcopenia was assessed by the SARC-F tool (independent variable). Length of stay, use of mechanical ventilation, and in-hospital mortality were the dependent variables, collected via an electronic medical chart. Data were analyzed by simple and multiple linear and logistic regression.

RESULTS

SARC-F explained 62% of length of stay, adjusted for the confounding variables age, male sex, and use of continuous medication, mechanical ventilation, and corticosteroids. Risk of sarcopenia was also associated with mechanical ventilation during hospitalization (odds ratio = 1.398; 95% CI, 1.018-1.919). SARC-F was not related to mortality.

CONCLUSION

Older adults with cardiovascular diseases hospitalized at greater risk of sarcopenia were more likely to need invasive mechanical ventilation and more prone to prolonged hospital stays.

Acute Skeletal Muscle Wasting is Associated with Prolonged Hospital Stay in Critical Illness with Brain Injury

BACKGROUND

Acute muscle wasting is common in critically ill patients, and this can lead to unfavorable clinical outcomes. The aim of this study was to identify factors associated with muscle wasting and to investigate the association between skeletal muscle wasting and prolonged hospital stay in critically ill patients with acute brain injury.

METHODS

This single-center prospective observational study was conducted in critically ill patients with acute brain injury who stayed in the intensive care unit for at least 1 week. The rectus femoris cross-sectional area was measured via ultrasound at baseline and a week after the first assessment. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted prolonged hospital stay.

RESULTS

A total of 86 patients were included in the study. Their mean age was 49.4 ± 16.9 years, 57% were male, and 46.5% had an admission diagnosis of subarachnoid hemorrhage. The percentage change in the rectus femoris cross-sectional area was 15.8% (95% confidence interval [CI] - 19.8% to - 12.0%; p < 0.001), and 57% of all patients had acute muscle wasting. According to the univariate analysis, there was a significant association between prolonged hospital stay and acute muscle wasting (odds ratio [OR] 3.677; 95% CI 1.487-9.043; p = 0.005), mechanical ventilation status (OR 3.600; 95% CI 1.455-8.904; p = 0.006), and Glasgow Coma Scale score (OR 0.888; 95% CI 0.808-0.976; p = 0.014) at intensive care unit admission. The multivariate analysis demonstrated that acute muscle wasting (OR 3.449; 95% CI 1.344-8.853; p = 0.010) was an independent risk factor for prolonged hospital stay.

CONCLUSIONS

There was considerable muscle wasting in critically ill patients with brain injuries over a 1-week period. Acute muscle wasting was associated with prolonged hospital stay in critically ill patients with acute brain injury.

Body composition parameters in initial CT imaging of mechanically ventilated trauma patients: Single-centre observational study

BACKGROUND

Body composition parameters provide relevant prognostic significance in critical care cohorts and cancer populations. Published results regarding polytrauma patients are inconclusive to date. The goal of this study was to analyse the role of body composition parameters in severely injured trauma patients.

METHODS

All consecutive patients requiring emergency tracheal intubation and mechanical ventilation before initial computed tomography (CT) at a level-1 trauma centre over a 12-year period (2008-2019) were reanalysed. The analysis included CT-derived body composition parameters based upon whole-body trauma CT as prognostic variables for 30-day mortality, intensive care unit length of stay (ICU LOS) and mechanical ventilation duration.

RESULTS

Four hundred seventy-two patients (75% male) with a median age of 49 years, median injury severity score of 26 and 30-day mortality rate of 22% (104 patients) met the inclusion criteria and were analysed. Regarding body composition parameters, 231 patients (49%) had visceral obesity, 75 patients had sarcopenia (16%) and 35 patients had sarcopenic obesity (7.4%). After adjustment for statistically significant univariable predictors age, body mass index, sarcopenic obesity, visceral obesity, American Society of Anesthesiologists classification ≥3, injury severity score and Glasgow Coma Scale ≤ 8 points, the Cox proportional hazard model identified sarcopenia as significant prognostic factor of 30-day mortality (hazard ratio 2.84; 95% confidence interval 1.38-5.85; P = 0.004), which was confirmed in Kaplan-Meier survival analysis (log-rank P = 0.006). In a subanalysis of 363 survivors, linear multivariable regression analysis revealed no significant associations of body composition parameters with ICU LOS and duration of mechanical ventilation.

CONCLUSIONS

In a multivariable analysis of mechanically ventilated trauma patients, CT-defined sarcopenia was significantly associated with 30-day mortality whereas no associations of body composition parameters with ICU LOS and duration of mechanical ventilation were observed.

A Multidimensional Approach to the Management of Patients in Prolonged Weaning from Mechanical Ventilation: The Concept of Treatable Traits - A Narrative Review

BACKGROUND

Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of treatable traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases. It is based on a multidimensional assessment of specific characteristics, which can be addressed by specific interventions that go beyond traditional diagnostic criteria. The concept is increasingly adopted for other complex diseases.

SUMMARY

This is a narrative review and an expert opinion on the development of a concept of TTs for patients undergoing prolonged weaning. The proposed TTs are based on a systematic review of risk factors for prolonged weaning, an analysis of claims data to assess risk factors within 96 h of IMV onset and data from the WEAN SAFE study. A multidisciplinary team identified clinically important TTs and determined appropriate interventions. The following TTs have been identified: airway disorders and complications associated with tracheostomy or intubation, such as airway obstruction, strictures or tracheomalacia, infectious aspects, anxiety, depression, delirium, post-traumatic stress disorder, anemia, pulmonary and cardio-renal disease. The multidimensional holistic approach also includes tailored sedation and pain management, nutritional therapy, early mobilization, and physiotherapy.

KEY MESSAGE

We propose a framework of relevant considerations for a multidimensional approach to the management of patients undergoing prolonged weaning that supports the regain of respiratory capacity, reduces the respiratory load, and thus could resolve the respiratory workload imbalance.

Association of frailty and sarcopenia with short-term mortality in older critically ill patients

BACKGROUND

There is still no study on the use of the SARC-CalF questionnaire for older critically ill patients. Moreover, there is limited evidence on whether a combination of sarcopenia and frailty can provide incremental improvements in risk stratification for older critically ill patients.

METHODS

A total of 653 patients older than 60 years were recruited. We used the clinical frailty scale (CFS) and SARC-CalF questionnaire to assess the frailty status and sarcopenia risk, respectively, of older patients shortly after admission to the ICU. The effect of frailty and sarcopenia risk on ICU mortality and 30-day mortality was evaluated.

RESULTS

A total of 147 (22.5%) patients died in the ICU, and 187 (28.6%) patients died within 30 days after ICU admission. The CFS score was associated with increased ICU mortality [per 1-score increase: odds ratio (OR) = 1.222, 95% confidential interval (CI): 1.003-1.489] and 30-day mortality (per 1-score increase: OR = 1.307, 95% CI: 1.079-1.583). The SARC-CalF score was also associated with increased ICU mortality (per 1-score increase: OR = 1.204, 95% CI: 1.120-1.294) and 30-day mortality (per 1-score increase: OR = 1.247, 95% CI: 1.163-1.337). The addition of the CFS + SARC-CalF score to Acute Physiology and Chronic Health Evaluation (APACHE) II improved discrimination and reclassified ICU and 30-day mortality risk.

CONCLUSIONS

Sarcopenia risk assessed by the SARC-CalF questionnaire provided independent prognostic information for older critically ill patients. A combination of sarcopenia and frailty improved the prediction of mortality for older critically ill patients and thus might be useful in the clinical decision-making process.

Cluster analysis of thoracic muscle mass using artificial intelligence in severe pneumonia

Severe pneumonia results in high morbidity and mortality despite advanced treatments. This study investigates thoracic muscle mass from chest CT scans as a biomarker for predicting clinical outcomes in ICU patients with severe pneumonia. Analyzing electronic medical records and chest CT scans of 778 ICU patients with severe community-acquired pneumonia from January 2016 to December 2021, AI-enhanced 3D segmentation was used to assess thoracic muscle mass. Patients were categorized into clusters based on muscle mass profiles derived from CT scans, and their effects on clinical outcomes such as extubation success and in-hospital mortality were assessed. The study identified three clusters, showing that higher muscle mass (Cluster 1) correlated with lower in-hospital mortality (8% vs. 29% in Cluster 3) and improved clinical outcomes like extubation success. The model integrating muscle mass metrics outperformed conventional scores, with an AUC of 0.844 for predicting extubation success and 0.696 for predicting mortality. These findings highlight the strong predictive capacity of muscle mass evaluation over indices such as APACHE II and SOFA. Using AI to analyze thoracic muscle mass via chest CT provides a promising prognostic approach in severe pneumonia, advocating for its integration into clinical practice for better outcome predictions and personalized patient management.

Skeletal Muscle Mass Assessment in Pediatric Patients: Development of a Normative Equation and Assessment of Factors Associated With a Low Skeletal Muscle Mass in PICU Patients

OBJECTIVES

To develop an equation for defining a low skeletal muscle mass (SMM) in children and to investigate risk factors and outcomes associated with low SMM in critically ill pediatric patients.

DESIGN

Single-center retrospective pediatric cohorts, 2011-2018.

SETTING

Tertiary Emergency and Critical Care Center of Kyushu University Hospital in Japan.

PATIENTS

We studied two cohorts of pediatric patients 1-15 years old who underwent abdominal CT at the level of the third lumbar vertebra (L3). First a cohort of trauma patients presented to the emergency department in whom we developed an SMM regression equation. Second, a cohort of patients who had undergone abdominal CT within 3 days of PICU admission.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The equation for estimating normal SMM used sex, age, and weight. Low SMM was defined as less than 80% of normal. In the 112 patients in the PICU cohort, median (range) age was 68 (13-191) months, and 83 (74.1%) had underlying disease. There was low SMM in 54 patients (48.2%). Regarding associations, using odds ratio (OR) and 95% CI, we found that low dietary intake (OR 4.33 [95% CI, 1.37-13.70]; p = 0.013) and the presence of underlying disease (OR 7.44 [95% CI, 2.10-26.30]; p = 0.002) were independently associated with greater odds of low SMM. Low SMM, compared with normal SMM, was also associated with longer hospital stays (42.5 d vs. 20.5 d; p = 0.007; β, 1.59; 95% CI, 1.09-2.33; p = 0.016).

CONCLUSIONS

In this retrospective PICU cohort from a single center in Japan, we found that low SMM at PICU admission was present in almost half the cases. Low SMM, as defined by being less than 80% of the normal, was associated with greater odds of low dietary intake and underlying chronic disease. Furthermore, low SMM was associated with longer hospital stays.

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3-5 years.

Combined ultrasound of m. quadriceps and diaphragm to determine the occurrence of sarcopenia and prolonged ventilation in a COVID-19 ICU cohort: The COVID-SARCUS trial

OBJECTIVE

The aim of this study was to determine the development of sarcopenia in a COVID-19 intensive care unit population by sequential quadriceps and diaphragm ultrasound and its relationship with hospital outcomes.

METHODS

We assessed muscle thickness, cross-sectional area, fascicle length, pennation angle, and echo intensity within 48 h after intubation, at days 5 and 10 and at discharge from the intensive care unit in 30 critically ill patients with confirmed COVID-19.

RESULTS

A different evolution of muscle thickness of the diaphragm and m. rectus femoris was observed; the changes between the two muscles were not correlated (Pearson's χ2 3.91, P = 0.419). The difference in muscle thickness was linked to the outcome for both m. rectus femoris and diaphragm, with the best survival seen in the group with stable muscle thickness. The greatest loss of muscle thickness occurred between days 5 and 10. The echo intensity was higher in the patients with increased muscle thickness, who also had a worse prognosis. There was a correlation between cross-sectional area on day 5 and handgrip strength (r = 0.290, P = 0.010). Only 31% of patients were able to return to their preadmission residence without any additional rehabilitation.

CONCLUSIONS

Muscle atrophy and decline in muscle strength appear in the earliest stages after admission to the intensive care unit and are related to functional outcome.

Frailty and sarcopenia: A bibliometric analysis of their association and potential targets for intervention

Frailty and sarcopenia are age-related diseases, and exhibit a concomitant relationship, as they share many common clinical features and etiological factors. Transitions within frailty status would be influenced by the presence of sarcopenia. Investigating their association to devise efficacious intervention and management strategies for geriatric patients is imperative, given their potentially unfavorable outcomes. In this study, the literature on sarcopenia and frailty was screened in the Web of Science core collection database over the past 30 years to ascertain the link between them through bibliometric analysis and the exploration of disease-related molecular pathways within the GeneCards and OMIM databases was conducted. Per inclusion and exclusion criteria, 3889 literature sources were selected for subsequent analysis. Keywords, including "cirrhosis" and "postoperative complications," represent the current and potential future research trends and focal points in this field. Moreover, 63 common potential targets between the two diseases were identified. Their pathogenesis involved cellular aging and endocrine metabolism regulation pathways, including AMPK, cell senescence, and the endocrine resistance pathway. This study identified an intimate correlation between frailty and sarcopenia in pathogenesis, prevention, and treatment measures, establishing a foundation for exploring shared prevention and treatment strategies for these two disorders.

Hospital-associated sarcopenia and the preventive effect of high energy intake along with intensive rehabilitation in patients with acute stroke

OBJECTIVES

Hospital-associated sarcopenia is prevalent and associated with poor outcomes in acutely admitted patients. Prevention of developing sarcopenia during hospitalization is an important factor in stroke management. Therefore, this study aimed to investigate whether energy intake and rehabilitation duration contribute to the prevention of hospital-associated sarcopenia in patients with acute stroke.

METHODS

Patients with acute stroke were included in this study. Energy intake during the first week of hospitalization was classified as "high" or "low" based on the reported cutoff value. Rehabilitation time during hospitalization was classified as "intense" or "mild" based on the median. The four groups were compared based on the combinations of high or low energy intake and intense or mild rehabilitation. The primary outcome was the development of sarcopenia during hospitalization. The secondary outcome was the Functional Independence Measure motor item gain during hospitalization. Multivariate analysis was performed with the primary or secondary outcome as the dependent variable and the effect of each group on the outcome was examined.

RESULTS

A total of 112 participants (mean age = 70.6 y; 63 men) were included in the study. Multivariate analysis found that high × intense (odds ratio = 0.113; P = 0.041) was independently associated with the development of sarcopenia during hospitalization (i.e., hospital-related sarcopenia). High × intense (β = 0.395; P < 0.001) was independently associated with the gain of Functional Independence Measure motor items.

CONCLUSIONS

In patients with acute stroke, the combination of high energy intake and adequate rehabilitation time is associated with prevention of hospital-associated sarcopenia.

Association between sarcopenia with incident cardio-cerebrovascular disease: A systematic review and meta-analysis

Sarcopenia is an age-associated skeletal muscle disease characterized by the progressive loss of muscle mass and function. The objective of this systematic review and meta-analysis was to evaluate the associations between sarcopenia and cardio-cerebrovascular disease (CCVD). A comprehensive search of the PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane Library databases was conducted from their inception to April 1st, 2023. A total of eight cross-sectional studies involving 63,738,162 participants met the inclusion criteria. Pooled estimates of odds ratios (ORs) were calculated using random-effects models. The findings demonstrated a significant association between sarcopenia and an increased risk of CCVD (OR: 1.33, 95% CI: 1.18 - 1.50, I2 = 1%; p < 0.001). Subgroup analyses indicated that sarcopenia was associated with a 1.67-fold increase in the risk of stroke and a 1.31-fold increase in the risk of CVD. Four studies included in this review examined the association between sarcopenic obesity and the risk of CCVD, and the results revealed that sarcopenic obesity was associated with a higher risk of CCVD (OR: 1.64, 95% CI: 1.08 - 2.49, I2 = 69%; p < 0.001). Meta-regressions and sensitivity analyses consistently supported the robustness of the overall findings. In conclusion, sarcopenia and sarcopenic obesity are significantly associated with an elevated risk of developing CCVD. However, further prospective cohort studies are warranted to validate this relationship while controlling for confounding factors.

The impact of age-related syndromes on ICU process and outcomes in very old patients

In this narrative review, we describe the most important age-related "syndromes" found in the old ICU patients. The syndromes are frailty, comorbidity, cognitive decline, malnutrition, sarcopenia, loss of functional autonomy, immunosenescence and inflam-ageing. The underlying geriatric condition, together with the admission diagnosis and the acute severity contribute to the short-term, but also to the long-term prognosis. Besides mortality, functional status and quality of life are major outcome variables. The geriatric assessment is a key tool for long-term qualitative outcome, while immediate severity accounts for acute mortality. A poor functional baseline reduces the chances of a successful outcome following ICU. This review emphasises the importance of using a geriatric assessment and considering the older patient as a whole, rather than the acute illness in isolation, when making decisions regarding intensive care treatment.

High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock

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.

Critical Care Management of Acute-on-Chronic Liver Failure: Certainties and Unknowns

Intensive care unit (ICU) admission is frequently required in patients with decompensated cirrhosis for organ support. This entity, known as acute-on-chronic liver failure (ACLF), is associated with high short-term mortality. ICU management of ACLF is complex, as these patients are prone to develop new organ failures and infectious or bleeding complications. Poor nutritional status, lack of effective liver support systems, and shortage of liver donors are also factors that contribute to increase their mortality. ICU therapy parallels that applied in the general ICU population in some complications but has differential characteristics in others. This review describes the current knowledge on critical care management of patients with ACLF including organ support, prognostic assessment, early liver transplantation, and futility rules. Certainties and knowledge gaps in this area are also discussed.

Impact of sarcopenia on postoperative pulmonary complications after gastric cancer surgery: A retrospective cohort study

Background

Few studies have investigated the relationship between sarcopenia and postoperative pulmonary complications (PPCs) after gastric cancer surgery. This study aimed to explore the impact of sarcopenia on PPCs in patients who had undergone gastric cancer surgery.

Methods

We included patients who underwent a transabdominal radical gastrectomy between June 2016 and October 2020. Patients were divided into two groups according to the median prevalence rate of lumbar triplane skeletal muscle index (L3 SMI): sarcopenia group (≤37.5% percentile in male and female group) and non-sarcopenia group (>37.5% percentile in male and female group). Baseline characteristics, intraoperative and postoperative conditions, pulmonary complications, and overall complications were compared between the two groups. The primary outcome was the incidence of PPCs. The secondary outcomes were overall postoperative complications and length of stay (LOS).

Results

Among the 143 patients included, 50 had sarcopenia and 93 had not. Compared to the non-sarcopenia group, the sarcopenia group had a higher the incidence of PPCs (22.0% vs. 8.6%, P = 0.024). The incidence of overall postoperative complications in the sarcopenia group was higher than that in the non-sarcopenia group (36.00% vs. 20.43%, P = 0.043). There was no significant difference in the LOS between the two groups.

Conclusions

Our research indicates that sarcopenia, preoperative comorbidities, and longer duration of intraoperative oxygen saturation <95% were risk factors for PPCs. Sarcopenia is an independent risk factor for postoperative complications. Given that our results provided a correlation rather than causation, future prospective randomized trials are needed to confirm the relationship between sarcopenia and prognosis.