Impact of Sarcopenia on Clinical Outcomes in a Cohort of Caucasian Active Crohn’s Disease Patients Undergoing Multidetector CT-Enterography

Abstract

(1) Background: Sarcopenia has a high incidence in Crohn’s disease (CD) with considerable heterogeneity among ethnicities and variable impact on clinical outcomes. Aim: to assess the impact of sarcopenia on clinical outcomes in a cohort of Caucasian patients with active CD undergoing CT-enterography (CTE) for clinical assessment. We further investigated the prevalence of sarcopenia and its predictors. (2) Methods: Caucasian CD patients with moderate–severe clinical activity, who underwent CTE in an emergency setting, were retrospectively recruited. The skeletal muscle index (SMI) at the third lumbar vertebra was used to detect sarcopenia in the early stages. Clinical malnutrition was defined according to global clinical nutrition criteria. Clinical outcomes included the rate of surgery and infections within one year. (3) Results: A total of 63 CD patients (34 M; aged 44 ± 17 years) were recruited, and 48 patients (68.3%) were sarcopenic. Malnutrition occurred in 28 patients (44.4%) with a significant correlation between body mass index (BMI) and sarcopenia (r = 0.5, p < 0.001). The overall rate of surgery was 33%, without a significant difference between sarcopenic and non-sarcopenic (p = 0.41). The rate of infection in patients with sarcopenia was significantly higher than in non-sarcopenic (42%vs15%, p = 0.03). BMI (OR 0.73,95%, CI 0.57–0.93) and extraintestinal manifestations (EIM) (OR 19.2 95%, CI 1.05–349.1) were predictive of sarcopenia (p < 0.05). (4) Conclusions: Sarcopenia was associated with an increased rate of infections, and it was observed in 68.3% of the Caucasian cohort with active CD.

Diagnostic Criteria and Prognostic Relevance of Sarcopenia in Patients with Inflammatory Bowel Disease—A Systematic Review

“…Boparai et al [28] reported that the BMI in CD patients with sarcopenia was lower than in CD patients without sarcopenia, 17.2 ± 4.5 vs. 21.5 ± 3.4, p = 0.001, and so did Nardone et al, 20.3 ± 3.1 vs. 23.3 ± 3.8, p = 0.002, and Ge X et al, 20.2 ± 3.5 vs. 21.3 ± 3.0, p= 0.006 in UC patients, while Nam et al reported that BMI is higher in both CD and UC patients with sarcopenia than in patients without sarcopenia, 20.1 ± 3.3 vs. 19.2 ± 3.3 p < 0.0001, 22.4 ± 3.9 vs. 21.6 ± 2.7, p < 0.0001, with no significant difference between CD and UC in the mean BMI [28,29,34,35,39]. Zhou et al reported that low BMI is associated with adverse outcomes such as the need for intestinal surgery, initiation of anti-TNF therapy, or an escalation of biologic therapy.…”

“…It reported the characteristics only in subgroups of CD and UC patients, respectively. From a total of 16 articles, 5 articles defined sarcopenia with the aid of the skeletal muscle index (SMI) with different cut-off values [28,29,31,34,35], as seen in Table 2. Data on sarcopenia and its correlation with body composition-BMI, visceral fat (VF), subcutaneous fat (SC)-and VF/SC index, are seen in Table 3.…”

Nutritional status in perianal Crohn’s disease: are we underestimating the impact?

“…Nardone et al ( 28 ) retrospectively evaluated the presence of sarcopenia in a cohort of 63 CD patients with moderate-to-severe clinical activity who underwent CT enterography. In total, 23.8% of patients presented perianal lesions in this cohort.…”

“…They detected sarcopenia signs in 68.3% of patients. Sarcopenia was associated with a higher risk of infections within 1 year ( 28 ). Furthermore, myopenia has also been associated with primary non-response to anti-TNF therapy ( 29 ).…”

Sarcopenia assessed by computed tomography or magnetic resonance imaging is associated with the loss of response to biologic therapies in adult patients with Crohn's disease

“…Sarcopenia is usually an aging-related disorder that results in a loss of muscle mass or function. 14 It is also highly prevalent (26.4%-68.3%) in CD patients [15][16][17][18] due to their chronic inflammation, gut microbiota, impaired protein synthesis, malabsorption and malnutrition, corticoid use, and insufficient physical activity due to fatigue. [19][20][21] Sarcopenia is associated with poorer outcomes, re-hospitalization, higher rates of surgery, and postoperative complications in patients with IBDs.…”