Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients

Mccusker, Ashley; Khan, Muhammad Fahad; Kulvatunyou, Narong; Zeeshan, Muhammad; Sakran, Joseph V.; Hayek, Haya; OʼKeeffe, Terence; Hamidi, Mohammad; Tang, Andrew; Joseph, Bellal

doi:10.1016/j.amjsurg.2018.07.024

Cited by 32 publications

(31 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current study, we employed CT imaging and a predetermined sex-specific TPA cut-off to estimate TPA and define sarcopenia. The incidence of sarcopenia was comparable to previous studies investigating cancer patients undergoing abdominal surgery (15–50%) and elderly patients suffering from trauma or surgery (24.9–57.5%) [17,21,30,31,35,36]. Since cross-sectional CT imaging is commonly performed in patients scheduled to receive abdominal operations, measurements of TPA are readily available and will not introduce further radiation exposure in this patient subgroup.…”

Section: Discussionsupporting

confidence: 81%

Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients

et al. 2019

View full text Add to dashboard Cite

Background Critically-ill surgical patients are at higher risk for sarcopenia, which is associated with worse survival. Sarcopenia may impair the respiratory musculature, which can subsequently influence the outcome of ventilator weaning. Although there are a variety of weaning parameters predictive of weaning outcomes, none have tried to incorporate “muscle strength” or “sarcopenia”. The aim of the current study was to explore the association between sarcopenia and difficult-to-wean (DtW) in critically-ill surgical patients. The influence of sarcopenia on ICU mortality was also analyzed. Methods Ninety-six patients undergoing mechanical ventilation in the surgical intensive care unit (ICU) were enrolled. Demographic data and weaning parameters were recorded from the prospectively collected database, and the total psoas muscle area (TPA) was determined at the level of the 3 rd lumbar vertebra by computed tomography. Sarcopenia was defined by previously established cut-off points and its influence on clinical outcomes was examined. Receiver operating characteristic (ROC) curve analysis was conducted to investigate the predictive capability of TPA and weaning parameters for predicting weaning outcomes. Results The median age of the studied patients was 73 years. Thirty patients (31.3%) were sarcopenic and 30 (31.3%) were defined as DtW. Eighteen patients (18.8%) had ICU mortality. Multivariate logistic regression analyses revealed that sarcopenia was an independent risk factor for DtW and ICU mortality. The area under the ROC curve (AUC) of TPA for predicting successful weaning was 0.727 and 0.720 in female and male patients, respectively. After combining TPA and conventional weaning parameters, the AUC for DtW increased from 0.836 to 0.911 and from 0.835 to 0.922 in female and male patients, respectively. Conclusion Sarcopenia is an independent risk factor for DtW and ICU mortality. TPA has predictive value when assessing weaning outcomes and can be used as an effective adjunct predictor along with conventional weaning parameters.

show abstract

Section: Discussionsupporting

confidence: 81%

Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…assessed the relationship between frailty, CT-derived psoas area and outcomes in older trauma patients, showing no statistically significant relationship between this method of sarcopenic assessment and in-hospital complications or mortality. 16 Using multivariable logistic regression, this current study identified a link between decreased muscle area and 30-day mortality.…”

Section: Discussionmentioning

confidence: 87%

“…There have been conflicting results in the literature, which comes mostly from the European and American ICU population, with some studies showing a relationship between sarcopenia and poor outcomes and others failing to demonstrate any relationship. 9–12,14,16–19 The majority of studies have targeted a specific patient group, such as the elderly, oncology, trauma or surgical patients. 9–12,14,16–19…”

Section: Introductionmentioning

confidence: 99%

A retrospective observational study of sarcopenia and outcomes in critically ill patients

Joyce

O'Dempsey

Kirby

et al. 2020

Anaesth Intensive Care

View full text Add to dashboard Cite

Frailty assessment in patients admitted to intensive care is often limited using traditional clinical frailty assessment tools. Opportunistic use of contemporary computed tomography (CT) can provide an objective estimate of low skeletal muscle mass (sarcopenia) as a proxy for frailty. The aim of this study was to establish the prevalence of sarcopenia in an Australian intensive care unit (ICU) population and to examine the relationship between sarcopenia and clinical outcomes. We undertook a single centre retrospective study of 1085 adult patients admitted to a single ICU over 12 months. Patients with a contemporary CT scan including the L3 vertebral body were included. Patients were categorised as sarcopenic or non-sarcopenic using previously published data. A total of 279 patients with a mean age of 67 years had an eligible CT scan; 163 (58%) were male. Higher 30-day mortality was associated with the use of CRRT (continuous renal replacement therapy) during the ICU admission (OR 6.84, P < 0.001) and also associated with lower cross-sectional muscle area (odds ratio (OR) 0.98, P = 0.004). Sarcopenia was found to be highly prevalent in this particular Australian ICU population (68%) and associated with older age (68 versus 55 years, P < 0.001), lower body mass index (27 versus 32 kg m−2, P < 0.001), more comorbidities (3 versus 2, P = 0.009), and longer stays in hospital (279 versus 223 h, P = 0.043). As a continuous predictor, lumbar muscle mass was associated with 30-day mortality with and without adjusting for other covariates.

show abstract

“…Among elderly, body composition has been suggested as a surrogate marker for baseline health status and future healthy life. However, studies on the impact of sarcopenia or muscle mass reduction on functional prognosis or mortality showed conflicting results 9,24–27 . Two prospective cohort studies demonstrated weak or no association between low muscle mass measured in the inferior limbs and long‐term mortality risk in elderly individuals 25,28 .…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous fat area at the upper thigh level is a useful prognostic marker in the elderly with femur fracture

Kim

Seo

et al. 2021

J cachexia sarcopenia muscle

View full text Add to dashboard Cite

Background The aim of this study was to evaluate prognostic value of body tissue composition at the upper thigh level for 1 year mortality in elderly patients with proximal femur fracture. Methods This retrospective cohort study included consecutive elderly (aged ≥65) patients diagnosed with proximal femur fracture based on the findings of pelvic bone computed tomography (CT) performed at the emergency department of a tertiary care hospital and treated with surgery between 2010 and 2017. The cross‐sectional area of subcutaneous fat and skeletal muscle at the upper thigh level was measured using CT. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 1 year mortality were estimated using a Cox proportional hazards model. Survival based on the SFA quartiles was assessed using nonparametric Kaplan–Meier survival analysis and compared used log‐rank tests. Results Among 876 elderly patients included in this study, the median age was 79.0 years, and 646 (73.7%) patients were female. A total of 93 (10.6%) died within 1 year after admission to the emergency department. Survivors had a significantly higher median subcutaneous fat area (SFA) than non‐survivors (170.2 vs. 133.0 cm2, P < 0.001), but no significant difference was observed between the skeletal muscle area (median, 156.7 vs. 160.3 cm2, P = 0.504) and muscle density (median, 19.0 vs. 19.1 HU, P = 0.861) of both groups. After adjustment of other clinical characteristics and body compositions, the multivariate Cox proportional hazard analysis showed that SFA (adjusted HR, 0.987; 95% CI, 0.982–0.992; P < 0.001) was independently associated with 1 year mortality. With 384 deaths during 51 322 person‐months of follow‐up, the median estimated survival duration of all the patients was 92.8 months (95% CI, 80.8–104.7 months). The patients with SFA in the third (165.6–195.0 cm2) and fourth (>195.0 cm2) quartiles showed significantly longer survival duration than those with SFA in the first (<131.4 cm2; median survival time, 51.3 months) and second (131.4–165.5 cm2; median survival time, 88.7 months) quartiles (P < 0.001 by log‐rank test). Conclusions The SFAs measured at the upper thigh level and 1 year mortality are positively associated in elderly patients with proximal femur fracture. SFA may be an independent prognostic biomarker for 1 year mortality of femur fracture.

show abstract

Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients

Cited by 32 publications

References 20 publications

Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients

Sarcopenia is an effective predictor of difficult-to-wean and mortality among critically ill surgical patients

A retrospective observational study of sarcopenia and outcomes in critically ill patients

Subcutaneous fat area at the upper thigh level is a useful prognostic marker in the elderly with femur fracture

Contact Info

Product

Resources

About