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Keshoofi P, Schindler P, Rennebaum F, Cordes F, Morgul H, Wildgruber M, Heinzow HS, Pascher A, Schmidt HH, Hüsing-Kabar A, Praktiknjo M, Trebicka J, Seifert LL. Imaging-based diagnosis of sarcopenia for transplant-free survival in primary sclerosing cholangitis. BMC Gastroenterol 2024; 24:145. [PMID: 38664624 PMCID: PMC11044284 DOI: 10.1186/s12876-024-03232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Imaging-based assessment of sarcopenia is a well-validated prognostic tool for patients with chronic liver disease. However, little is known about its value in patients with primary sclerosing cholangitis (PSC). This cross-sectional study aimed to investigate the predictive value of the cross-sectional imaging-based skeletal muscle index (SMI) for transplant-free survival (TFS) in patients with PSC. METHODS A total of 95 patients with PSC who underwent abdominal cross-sectional imaging between 2008 and 2022 were included in this retrospective study. SMI was measured at the third lumbar vertebra level (L3-SMI). The cut-off values to define sarcopenia were < 50 cm²/m² in male patients and < 39 cm²/m² in female patients. The primary outcome of this study was TFS, which was defined as survival without liver transplantation or death from any cause. RESULTS Our study indicates that L3-SMI sarcopenia impairs TFS in patients with PSC (5-year TFS: 33.9% vs. 83.3%, p = 0.001, log-rank test). L3-SMI sarcopenia was independently associated with reduced TFS via multivariate Cox regression analysis (HR = 2.749; p = 0.028). Body mass index reduction > 10% at 12 months, which is used as MELD standard exception (SE) criterion in Eurotransplant (in Germany only until September 2023), was not significantly associated with TFS in the multivariate Cox regression analysis (HR = 1.417; p = 0.330). Substitution of BMI reduction with L3-SMI in the German SE criteria improved the predictive accuracy of TFS compared to the established SE criteria (multivariable Cox regression analysis: HR = 4.007, p < 0.001 vs. HR = 1.691, p = 0.141). CONCLUSION Imaging-based diagnosis of sarcopenia via L3-SMI is associated with a low TFS in patients with PSC and may provide additional benefits as a prognostic factor in patient selection for liver transplantation.
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Affiliation(s)
- Pedram Keshoofi
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany.
| | - Philipp Schindler
- Clinic for Radiology, University Hospital Muenster, 48149, Muenster, Germany
| | - Florian Rennebaum
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Friederike Cordes
- Medical Clinic II, Euregio Hospital Nordhorn, 48529, Nordhorn, Germany
| | - Haluk Morgul
- Department for General, Visceral and Transplant Surgery, University Hospital Muenster, 48149, Muenster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital LMU Munich, 81377, Munich, Germany
| | - Hauke S Heinzow
- Department of Internal Medicine I, Krankenhaus der Barmherzigen Brüder, 54292, Trier, Germany
| | - Andreas Pascher
- Department for General, Visceral and Transplant Surgery, University Hospital Muenster, 48149, Muenster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Michael Praktiknjo
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Jonel Trebicka
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany
| | - Leon Louis Seifert
- Medical Clinic B, Department of Gastroenterology, Hepatology, Endocrinology, Infectiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Bldg. A14, 48149, Muenster, Germany.
- The Rockefeller University Center for Clinical and Translational Science, 10065, New York, NY, United States of America.
- Laboratory of Virology and Infectious Disease, The Rockefeller University, 10065, New York, NY, United States of America.
- The Rockefeller University Hospital, 1230 York Avenue, 10065, New York, NY, USA.
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March C, Thormann M, Geipel S, Sowa JP, Barajas Ordonez F, Pech M, Omari J, Lemmer P. Increase of radiologically determined muscle area in patients with liver cirrhosis after transjugular intrahepatic portosystemic shunt. Sci Rep 2023; 13:17092. [PMID: 37816875 PMCID: PMC10564886 DOI: 10.1038/s41598-023-43938-6] [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: 07/10/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
Sarcopenia is common in patients with liver cirrhosis and related to higher mortality. Implantation of a transjugular intrahepatic portosystemic shunt (TIPS) is a feasible method for reducing cirrhosis-related portal hypertension, but also possible improvement of the patient`s muscle status. We aimed to analyze changes in muscle quantity and prevalence of sarcopenia after TIPS. We retrospectively surveyed the muscle status in 52 patients (mean age 54.2 years) before and after TIPS by evaluating skeletal (SMI) and psoas muscle indices (PMI) in CT and MR images. Model for End-Stage Liver Disease (MELD), Freiburg index of post-TIPS survival (FIPS), and their underlying laboratory parameters (e.g., Albumin) were analyzed. Prevalence of sarcopenia was 84.6%. After a median follow-up of 16.5 months after TIPS, SMI (0.020) and PMI (p < 0.001) increased, and sarcopenia decreased by 14.8% (0.109). MELD and PMI after TIPS were negatively correlated (r = - 0.536, p < 0.001). Albumin levels increased in patients with increased SMI after TIPS (p = 0.022). Confirming the positive impact of TIPS implantation on muscle indices in patients with liver cirrhosis, we found indications for improved survival and possible indications for altered metabolism with increased albumin levels in patients with increased muscle quantity.
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Affiliation(s)
- Christine March
- Department of Radiology and Nuclear Medicine, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany.
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Maximilian Thormann
- Department of Radiology and Nuclear Medicine, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Sarah Geipel
- Department of Radiology and Nuclear Medicine, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Jan-Peter Sowa
- Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr University, Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Felix Barajas Ordonez
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
| | - Peter Lemmer
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-Von-Guericke University Magdeburg, Leipziger Str. 44, 39112, Magdeburg, Germany
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Petric M, Jordan T, Karteek P, Licen S, Trotovsek B, Tomazic A. Radiological assessment of skeletal muscle index and myosteatosis and their impact postoperative outcomes after liver transplantation. Radiol Oncol 2023; 57:168-177. [PMID: 37341202 DOI: 10.2478/raon-2023-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Liver transplantation offers curative treatment to patients with acute and chronic end-stage liver disease. The impact of nutritional status on postoperative outcomes after liver transplantation remains poorly understood. The present study investigated the predictive value of radiologically assessed skeletal muscle index (SMI) and myosteatosis (MI) on postoperative outcomes. PATIENTS AND METHODS Data of 138 adult patients who underwent their first orthotopic liver transplantation were retrospectively analysed. SMI and MI in computer tomography (CT) scan at the third lumbar vertebra level were calculated. Results were analyzed for the length of hospitalisation and postoperative outcomes. RESULTS In 63% of male and 28.9% of female recipients, low SMI was found. High MI was found in 45(32.6%) patients. Male patients with high SMI had longer intensive care unit (ICU) stay (P < 0.025). Low SMI had no influence on ICU stay in female patients (P = 0.544), length of hospitalisation (male, P > 0.05; female, P = 0.843), postoperative complication rates (males, P = 0.883; females, P = 0.113), infection rate (males, P = 0.293, females, P = 0.285) and graft rejection (males, P = 0.875; females, P = 0.135). The presence of MI did not influence ICU stay (P = 0.161), hospitalization (P = 0.771), postoperative complication rates (P = 0.467), infection rate (P = 0.173) or graft rejection rate (P = 0.173). CONCLUSIONS In our study, changes in body composition of liver transplant recipients observed with SMI and MI had no impact on postoperative course after liver transplantation. CT body composition analysis of recipients and uniformly accepted cut-off points are crucial to producing reliable data in the future.
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Affiliation(s)
- Miha Petric
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Taja Jordan
- Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Popuri Karteek
- Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sabina Licen
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Blaz Trotovsek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ales Tomazic
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Kim M, Lee CM, Kang BK, Ha TK, Choi YY, Lee SJ. Sarcopenia assessed with DXA and CT increases the risk of perioperative complications in patients with gastrectomy. Eur Radiol 2023:10.1007/s00330-023-09401-w. [PMID: 36637463 DOI: 10.1007/s00330-023-09401-w] [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: 08/24/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We investigated sarcopenia prevalence using various diagnostic criteria based on dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) in gastric cancer patients who underwent gastrectomy, and evaluated the association between sarcopenia and perioperative complications. METHODS This retrospective study included consecutive patients with gastric cancer who underwent gastrectomy, and preoperative DXA and CT from January 2013 to November 2020. Body composition was measured using DXA and CT. Height-adjusted DXA-based Appendicular Skeletal Muscle Mass Index (ASMI) and CT-based skeletal muscle cross-sectional area at the L3 level (SMI) were measured. Sarcopenia and sarcopenic obesity were defined using reported cutoff values. The chi-square test and univariate analysis were performed to determine risk factors for significant and severe perioperative complications (Clavien-Dindo Grades ≥ 2 and ≥ 3, respectively). RESULTS In total, 77 males and 43 females aged 61.4 ± 11.0 years were included. ASMI and SMI were correlated (r = 0.819), but sarcopenia prevalence varied (20.0-63.3%), depending on the criteria applied. Univariate analysis revealed sarcopenia defined using the Asian Working Group on Sarcopenia (AWGS) criteria and sarcopenic obesity as risk factors for significant (odds ratio [OR] 2.76, p = 0.030 vs. OR 4.31, p = 0.002) and severe perioperative complications (OR 3.77, p = 0.036 vs. OR 4.78, p = 0.010). In subgroup analyses, sarcopenia and sarcopenic obesity were significantly associated with perioperative complications only in males. CONCLUSION Perioperative complication risk can be predicted from sarcopenia defined using the AWGS criteria and sarcopenic obesity measured using DXA and CT, particularly in males. KEY POINTS • The prevalence of sarcopenia varies due to definition differences. • Sarcopenia and sarcopenic obesity are risk factors for significant and severe perioperative complications, particularly in males. • Our results suggest that physicians need to pay attention to perioperative complications after surgical treatment of male patients with sarcopenia and sarcopenic obesity.
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Affiliation(s)
- Mimi Kim
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Tae Kyung Ha
- Department of Surgery, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea
| | - Soo Jin Lee
- Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea.
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5
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Walpot J, Herck PV, de Heyning CMV, Bosmans J, Massalha S, Inácio JR, Heidbuchel H, Malbrain ML. Computed tomography measured epicardial adipose tissue and psoas muscle attenuation: new biomarkers to predict major adverse cardiac events and mortality in patients with heart disease and critically ill patients. Part II: Psoas muscle area and density. Anaesthesiol Intensive Ther 2023; 55:243-261. [PMID: 38084569 PMCID: PMC10691466 DOI: 10.5114/ait.2023.132460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/28/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcopenia is a syndrome characterised by loss of skeletal muscle mass, loss of muscle quality, and reduced muscle strength, resulting in low performance. Sarcopenia has been associated with increased mortality and complications after medical interventions. In daily clinical practice, sarcopenia is assessed by clinical assessment of muscle strength and performance tests and muscle mass quantification by dual-energy X-ray absorptio-metry (DXA) or bioelectrical impedance analysis (BIA). Assessment of the skeletal muscle quantity and quality obtained by abdominal computed tomography (CT) has gained interest in the medical community, as abdominal CT is performed for various medical reasons, and quantification of the psoas and skeletal muscle can be performed without additional radiation load and dye administration. The definitions of CT-derived skeletal muscle mass quantification are briefly reviewed: psoas muscle area (PMA), skeletal muscle area (SMA), and transverse psoas muscle thickness (TPMT). We explain how CT attenuation coefficient filters are used to determine PMA and SMA, resulting in the psoas muscle index (PMI) and skeletal muscle index (SMI), respectively, after indexation to body habitus. Psoas muscle density (PMD), a biomarker for skeletal muscle quality, can be assessed by measuring the psoas muscle CT attenuation coefficient, expressed in Hounsfield units. The concept of low-density muscle (LDM) is explained. Finally, we review the medical literature on PMI and PMD as predictors of adverse outcomes in patients undergoing trauma or elective major surgery, transplantation, and in patients with cardiovascular and internal disease. PMI and PMD are promising new biomarkers predicting adverse outcomes after medical interventions.
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Affiliation(s)
| | - Paul Van Herck
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Caroline M. Van de Heyning
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Johan Bosmans
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | | | - João R. Inácio
- Centro Hospitalar Universitário Lisboa Norte/ Hospital de Santa Maria, Lisbon, Portugal
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Manu L. Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
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Mirzai S, Eck BL, Chen PH, Estep JD, Tang WHW. Current Approach to the Diagnosis of Sarcopenia in Heart Failure: A Narrative Review on the Role of Clinical and Imaging Assessments. Circ Heart Fail 2022; 15:e009322. [PMID: 35924562 PMCID: PMC9588634 DOI: 10.1161/circheartfailure.121.009322] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sarcopenia has been established as a predictor of poor outcomes in various clinical settings. It is particularly prevalent in heart failure, a clinical syndrome that poses significant challenges to health care worldwide. Despite this, sarcopenia remains overlooked and undertreated in cardiology practice. Understanding the currently proposed diagnostic process is paramount for the early detection and treatment of sarcopenia to mitigate downstream adverse health outcomes.
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Affiliation(s)
- Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Brendan L. Eck
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Po-Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Jerry D. Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, FL
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Tajiri K, Futsukaichi YH, Murayama A, Minemura M, Takahara T, Yasuda I. Chronic liver disease questionnaire to manage patients with chronic liver diseases. Hepatol Res 2022; 52:712-720. [PMID: 35505586 DOI: 10.1111/hepr.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although patients with chronic liver disease (CLD) usually show few symptoms, they exhibit decreased health-related QOL (HRQOL) with occurrence complications including hepatocellular carcinoma (HCC). Health-related QOL is an important indicator in the management of CLD. The Chronic Liver Disease Questionnaire (CLDQ) was established as a tool for assessment of HRQOL. In this study, we evaluate its usefulness for the management of daily clinical practice. METHODS Patients (N = 190, median age 70 years old) treated between 2016 and 2019 were registered and prospectively followed-up with annual CLDQ. Associations of liver function and development of factors for admission or death were evaluated. RESULTS Of the 190 patients registered, median age 70 years old, 140 were Child-A, 121 were Fib-4 index >2.67 and showed 80 HCC. All 6 domains including Systemic Symptoms (SS) were negatively correlated with Child-Pugh score more than with albumin-bilirubin score and Fib-4 index. A hundred four admission events and 49 deaths were found during observation period, and median event-free survival was 34.3 months. Treatment for HCC was the most frequent cause of admission, and 37 liver-related deaths were found. Systemic Symptoms score 2 years after registration was decreased in both HCC- and non-HCC cohort. Systemic Symptoms decreased and SS < 4 might be predictive for event occurrence. CONCLUSIONS CLDQ is useful to assess HRQOL in patients with CLD and is well correlated with liver function especially Child-Pugh. Chronic Liver Disease Questionnaire might be useful to predict the prognosis of CLD and can be a tool of management in clinical practice.
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Affiliation(s)
- Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | | | - Aiko Murayama
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Masami Minemura
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Terumi Takahara
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
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Tagliafico AS, Rossi F, Bignotti B, Torri L, Bonsignore A, Belgioia L, Domineitto A. CT-derived relationship between low relative muscle mass and bone damage in patients with multiple myeloma undergoing stem cells transplantation. Br J Radiol 2022; 95:20210923. [PMID: 34918544 PMCID: PMC9153728 DOI: 10.1259/bjr.20210923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Sarcopenia or low muscle mass is related to worse prognosis in cancer patients. We investigated whether muscle mass is related to bone damage on CT in patients with multiple myeloma (MM). METHODS Approval from the institutional review board was obtained. N = 74 consecutive patients (mean age, 60.8 years ± 9.24 [standard deviation]; range, 36-89 years) for MM who underwent transplant were included. Sarcopenia cut-off points defined as skeletal muscle index (SMI) used were<41 cm2/m2. To assess bone damage in MM the MSBDS (myeloma spine and bone damage score) was used. One-way analysis of variance and the X2 test were used. Kaplan-Meier analysis was performed to generate progression and survival curves according to SMI and MSBDS. The testing level was set at 0.05. RESULTS The median SMI was 47.1 ± 14.2 and according to SMI 18/74 (24%) had sarcopenia which was more prevalent in females (p.001). A strong and significant association between patients with low muscle mass and elevated bone damage (24/74, 32.4%) and patients with normal/non-low muscle mass low bone damage (30/74, 40.5%) was present. Multiple Logistic regression did not show any significant relationship or confounding influence among SMI and MSBDS regarding sex (p.127), cytogenetic status (p.457), staging (p.756) and relapse (.126). Neither SMI nor MSBDS resulted significantly related to overall survival as shown in Kaplan-Meier analysis. CONCLUSION Sarcopenia and bone damage affected MM patients undergoing stem cell transplantation and are significantly associated. ADVANCES IN KNOWLEDGE Quantitative measurement of sarcopenia and bone damage on CT resulted present in MM patients undergoing stem cell transplantation and are significantly associated.
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Affiliation(s)
| | | | | | - Lorenzo Torri
- Vascular
Surgery Unit, Azienda Ospedaliero Universitaria Pisana,
Pisa, Italy
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9
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Abstract
Sarcopenia indicates a loss of skeletal muscle mass, a condition that leads to a decline in physical performance. In 2018, the European Working Group on Sarcopenia in Older People met to update the original definition of sarcopenia: New scientific and clinical insights were introduced to emphasize the importance of muscle strength loss as a prime indicator of probable sarcopenia. In addition, the skeletal muscle is not only the organ related to mobility, but it is recognized as a secondary secretory organ too, with endocrine functions influencing several systems and preserving health. In this perspective, radiology could have a major role in early detection of sarcopenia and guarantee improvement in its treatment in clinical practice. We present here an update of clinical knowledge about sarcopenia and advantages and limitations of radiological evaluation of sarcopenia focusing on major body composition imaging modalities such as dual-energy X-ray absorptiometry, CT, and MRI. In addition, we discuss controversial such as the lack of consensus or standardization, different measurement methods, and diagnostic radiological cutoff points. Sarcopenia evaluation with radiological methods could enhance the role of radiologist in performing studies with relevant impact on medical and social outcome, placing radiology at the pinnacle of quality in evidence-based practice with high-level studies.
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Ye Q, Cai JJ, Yan JQ, Lv R. Role of L3-PMI in prognostic evaluation of patients with acute-on-chronic liver failure related to hepatitis B cirrhosis. Shijie Huaren Xiaohua Zazhi 2021; 29:1167-1173. [DOI: 10.11569/wcjd.v29.i20.1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sarcopenia has received widespread attention in patients with end-stage liver disease since it is an independent risk factor for death and is closely related to the prognosis of the patients. However, there is still a lack of unified detection methods and diagnostic criteria for sarcopenia.
AIM To evaluate the relationship between the third lumbar psoas muscle index (L3-PMI) and clinical indicators in patients with acute-on-chronic liver failure (ACLF) associated with hepatitis B cirrhosis and its role in prognostic evaluation.
METHODS A retrospective study was performed on 140 patients who were hospitalized at the Department of Hepatology, Tianjin Third Central Hospital from January 2014 to December 2017, met the ACLF diagnostic criteria for hepatitis B cirrhosis, and had abdominal CT data. The same researcher manually tracked the level of the lower edge of the third lumbar vertebra on the CT images of the patient's abdomen, measured the maximum anteroposterior and transverse diameters of the psoas major on both sides, and calculated the psoas major index. The relationship of L3-PMI with clinical characteristics and prognosis was then analyzed.
RESULTS The 140 patients were divided into a survival group with 102 cases and a death group with 38 cases according to their 90-d survival status. The L3-PMI value of patients in the death group was 4.89 cm2/m2 ± 1.42 cm2/m2, significantly lower than that of patients in the survival group (5.94 cm2/m2 ± 1.24 cm2/m2; P < 0.001). There was no statistical difference between the two groups in PLT, ALB, ALT, AST, SCr, or eGFR (P > 0.05). The WBC, INR, and MELD scores of the death group were significantly higher than those of the survival group, while the serum sodium was significantly lower than that of the survival group (P < 0.05). In addition, 33 ACLF patients with hepatic encephalopathy (HE) had an L3-PMI value of 5.17 cm2/m2 ± 1.49 cm2/m2, which was significantly lower than that of 107 patients without HE (P = 0.020). Among all ACLF patients, there were 120 males and 20 females. The L3-PMI value of the male group (5.92 cm2/m2 ± 1.23 cm2/m2) was significantly higher than that of the female group (4.03 cm2/m2 ± 0.92 cm2/m2; P < 0.05). The ROC curve of L3-PMI for predicting death by gender was plotted. The area under the ROC curve for males was 0.726, the cut-off value was 5.02, and the sensitivity and specificity were 85% and 50%, respectively. The area under the ROC curve for females was 0.774, the cut-off value was 4.60, and the sensitivity and specificity were 50% and 100%, respectively.
CONCLUSION L3-PMI has important clinical application value for evaluating the prognosis of ACLF patients related to hepatitis B liver cirrhosis.
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Affiliation(s)
- Qing Ye
- Department of Hepatology, The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin 300170, China
| | - Jun-Jun Cai
- Department of Hepatology, The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin 300170, China
| | - Jun-Qing Yan
- Department of Hepatology, The Third Central Hospital of Tianjin, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin 300170, China
| | - Rong Lv
- Radiology Department, The Third Central Hospital of Tianjin, Tianjin 300170, China
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