The importance of sarcopenia as a prognostic predictor of the clinical course in acute severe ulcerative colitis patients

Abstract

Background and aim: Acute severe ulcerative colitis (ASUC) is a life-threatening condition that requires timely referral for therapy. Sarcopenia has been associated with clinical outcomes of inflammatory bowel disease (IBD). This study investigated the role of sarcopenia in predicting the clinical course of ASUC. Methods: This retrospective cohort study included ASUC patients with abdominal CT scans. Univariate and multivariable regression analyses were performed to identify a practical predictive index for the clinical course of ASUC. Results: Of 233 included patients, 151 had intravenous corticosteroid (IVS) failure, among whom 32 received surgery without medical rescue therapy. Fifty patients underwent colectomy after medical rescue therapy failure. Of these 82 surgical patients, 42 suffered postoperative complications. Multivariable regression analysis showed that sarcopenia remained an independent risk factor for IVS failure (OR = 2.969; 95% CI, 1.547-5.701; p = 0.001), colectomy after medical rescue therapy failure (OR = 3.411; 95% CI, 1.147-10.141; p = 0.027), and postoperative complications after colectomy (OR = 4.157; 95% CI, 1.364-12.667; p = 0.012). During follow-up, patients with colectomy after first-line treatment had a lower comprehensive complication index and better health-related quality of life. Conclusion: Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.

The impact of sarcopenia on outcomes in patients with inflammatory bowel disease undergoing colorectal surgery

“…Seven of the nine published studies reported a positive association between sarcopenia and either overall, major, or infectious complications. 19,21,[23][24][25][26][27] While two of studies found no association between sarcopenia and postoperative complications. 20,22 Our study was consistent with this trend and showed an association between sarcopenia and major post-operative complications.…”

“…23 Five additional studies used SMI but defined sarcopenia according to different cut-off points. 19,22,24,25,27 The three remaining studies used less validated techniques to define sarcopenia. 20,21,26 Additionally, four of the studies used the lowest quartile of patients to define sarcopenia rather than validated cut-offs.…”

“…20,21,26 Additionally, four of the studies used the lowest quartile of patients to define sarcopenia rather than validated cut-offs. 20,21,26,27 This is likely to have underestimated the true number of patients with sarcopenia. The heterogeneity in definitions and rates of sarcopenia makes comparison difficult.…”

Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance

“…Table 1 shows the evaluation methods and frequency of sarcopenia reported in recent years in patients with IBD [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. In more than half of the reports, computed tomography (CT, L3 level) is used to assess sarcopenia, but many reports only use muscle mass assessment to determine sarcopenia, while a few include grip strength and walking speed in the assessment of sarcopenia [17].…”

“…Table 2 shows reports on the relationship between sarcopenia and prognoses in patients with IBD [19,23,26,27,[30][31][32]54,[80][81][82][83][84][85][86][87]. There have been numerous reports that sarcopenia is a poor prognostic factor in patients with IBD undergoing surgery [19,26,27,30,31,54,[81][82][83][84][85][86]. There are also reports that sarcopenia correlates with the severity of IBD [31,80].…”