Nutritional indices for screening sarcopenia before adult cardiac surgery

Abstract

Background Malnutrition can increase and exacerbate sarcopenia, and preoperative nutritional indices could have potential use as screening tools for sarcopenia in all patients, not only those with limited activity. Muscle strengths, such as grip strength, chair stand test, are used to screen for sarcopenia, but these measurements are time-consuming and cannot be applied to all patients. This retrospective study was conducted to determine whether nutritional indices can predict the presence of sarcopenia before adult cardiac surgery. Methods The study subjects were 499 patients aged ≥18 who had undergone cardiac surgery using a cardiopulmonary bypass (CPB). Bilateral psoas muscle mass areas at the top level of the iliac crest were measured by abdominal computed tomography. Preoperative nutritional statuses were evaluated using COntrolling NUTritional status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI). Receiver operating characteristic (ROC) curve analysis was used to identify the nutritional index that best predicted the presence of sarcopenia. Results The 124 patients (24.8%) in the sarcopenic group were older (69.0 vs. 62.0 years; P<0.001), and had a lower mean body weight (58.90 vs. 65.70 kg; P<0.001) and body mass index (BMI) (2.22 vs. 2.49 kg/m 2 ; P<0.001), and a poorer nutritional status than the 375 patients in the non-sarcopenic group. ROC curve analysis showed that NRI [area under the curve (AUC) 0.716, confidence intervals (CI): 0.664–0.768] better predicted the presence of sarcopenia than CONUT score (AUC 0.607, CI: 0.549–0.665) or PNI (AUC 0.574, CI: 0.515–0.633). The optimal NRI cut-off value was 105.25, which provided a sensitivity of 67.7% and a specificity of 65.1% for the prevalence of sarcopenia. The median durations of mechanical support (17 vs. 16 hours; P=0.008) and intensive care unit stay (3 vs. 2 days; P=0.001) were significantly longer in the sarcopenic group. Conclusions NRI offers a more straightforward, faster, and reproducible screening tool than muscle strength or mass measurement for identifying sarcopenia, and an alternative means of assessment in patients with limited activity before adult cardiac surgery.

Diagnostic Value of Nutritional Risk Index and Other Indices for Predicting Sarcopenia in the Middle-Aged and Elderly Population of China Without Cancer: A ROC Curve Analysis

“… 23 , 40 , 43 Similarly, the NRI has been identified as an independent predictor of sarcopenia presence and survival in cancer and surgery patients, suggesting it could serve as an alternative means of malnutrition assessment for populations with sarcopenia. 22 , 44 Our study confirmed NRI as a clinical indicator for independently predicting sarcopenia incidence, with a good predictive value, especially in middle-aged and elderly males. Compared to other derived inflammatory and nutritional biomarkers, NRI appears to be more promising for further study.…”

“… 38 To identify a biomarker that can effectively and efficiently screen for sarcopenia in the middle-aged and elderly population, we introduced inflammatory and nutritional biomarkers (PIV, ALI, PNI, and NRI/GNRI) that are widely used to evaluate therapeutic outcomes and predict prognosis in cancer patients with sarcopenia. 20 , 22 , 23 , 39 , 40 NRI, which combines albumin and weight loss, has been commonly utilized as an index of malnutrition in hospitalized adults. Compared to previous studies, our study provides a more comprehensive and scientifically rigorous analysis due to the relatively larger sample size and inclusion of indexes.…”

“…The derived inflammatory and nutritional biomarkers were calculated, respectively, as follows: PLR = platelet count/lymphocyte count, NLR = neutrophil count/lymphocyte count, LMR = lymphocyte count/monocyte count, SII = neutrophil count × platelet count/lymphocyte count, 27 SIRI = neutrophil count × monocyte count/lymphocyte count, 28 PIV = platelet count × neutrophil count × monocyte count/lymphocyte count, 29 ALI = BMI × albumin (g/dl)/NLR, 30 PNI = 10 × albumin (g/dl) + 0.005 × lymphocyte (/μL), 31 NRI = 1.519 × albumin (g/l) + 0.417 × (body weight/ideal weight × 100). 22 For the convenience of calculating NRI in the middle-aged and elderly population, ideal weight was adjusted as height (cm) - 105.…”

“…17,18 Other indices such as the pan-immune-inflammation value (PIV), advanced lung cancer inflammation index (ALI), prognostic nutritional index (PNI), and nutritional risk index (NRI) or geriatric nutritional risk index (GNRI) have shown correlations with sarcopenia and have been used to predict the overall survival or prognosis of patients with carcinoma. [19][20][21][22][23] Inflammatory and nutritional states can be influenced by sarcopenia, and alterations in the microenvironment can further exacerbate sarcopenia. Numerous studies have demonstrated an association between sarcopenia and systemic inflammatory and nutritional biomarkers.…”