Radiological Features for Frailty Assessment in Patients Requiring Emergency Laparotomy

Kołodziejska, Katarzyna; Witowski, Jan; Tylec, Piotr; Grochowska, Anna; Przytuła, Natalia; Lis, Maciej; Pędziwiatr, Michał; Rubinkiewicz, Mateusz

doi:10.3390/jcm11185365

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Frailty in EL patients has been found to represent a higher risk. [46][47][48][49] However, common frailty scores lack the objectivity provided by a numerical measurement from a CT image. Radiological sarcopenia can be a quantitative surrogate representation of physiological reserve in patients, providing valuable information on the hurdles to recovery.…”

Section: Discussionmentioning

confidence: 99%

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Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Ming

Howley

Holmes

et al. 2023

ANZ Journal of Surgery

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Background Risk assessment for emergency laparotomy (EL) is important for guiding decision‐making and anticipating the level of perioperative care in acute clinical settings. While established tools such as the American College of Surgeons National Surgical Quality Improvement Program calculator (ACS‐NSQIP), the National Emergency Laparotomy Audit Risk Prediction Calculator (NELA) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity calculation (P‐POSSUM) are accurate predictors for mortality, there has been increasing recognition of the benefits from including measurements for frailty in a simple and quantifiable manner. Psoas muscle to 3rd lumbar vertebra area ratio (PM:L3) measured on CT scans was proven to have a significant inverse association with 30‐, 90‐ and 365‐day mortality in EL patients. Methods A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016–2017, and had contemporaneous abdomino‐pelvic CT scans. Radiological sarcopenia was measured as PM:L3 ratios. ASC‐NSQIP, NELA and P‐POSSUM were retrospectively calculated. Univariate and multivariate logistic regression modelling was used to assess these ratios and scores, as well as American Society of Anaesthesiologists (ASA) classification separated into ASA I‐III and IV/V (simplified ASA), as potential predictors of 30‐, 90‐ and 365‐day mortality. Results PM:L3, simplified ASA, ACS‐NSQIP, NELA and P‐POSSUM were each statistically significant predictors of 30‐day, 90‐day and 365‐day mortality (P < 0.001). Logistic regression models of 30‐, 90‐ and 365‐day mortality combining PM:L3 (P = 0.001) and simplified ASA (P < 0.001) exhibited AUCs of 0.838 (0.780, 0.896), 0.805 (0.751, 0.860) and 0.775 (0.729, 0.822), respectively, which were comparable to that of ACS‐NSQIP and NELA. Conclusion Combining the semi‐physiological parameter ASA classification with PM:L3 provides a quick and simple alternative to the more complex established risk assessment scores and is superior to PM:L3 alone.

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Section: Discussionmentioning

confidence: 99%

“…Radiological sarcopenia or radiological assessment of body composition are becoming more popular in the field of risk assessment for surgical patients. Frailty in EL patients has been found to represent a higher risk 46–49 . However, common frailty scores lack the objectivity provided by a numerical measurement from a CT image.…”

Section: Discussionmentioning

confidence: 99%

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Ming

Howley

Holmes

et al. 2023

ANZ Journal of Surgery

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Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Demirel,

Rothenbühler,

Huber

et al. 2024

JCM

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Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998–1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927–0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99–1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.

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Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

Demirel,

Halavina,

Hamzaraj

et al. 2024

JCM

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Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95% CI: 1.01–1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068–1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.

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Radiological Features for Frailty Assessment in Patients Requiring Emergency Laparotomy

Cited by 3 publications

References 25 publications

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

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