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Medicine Sep 2022Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease... (Observational Study)
Observational Study
Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), or Child-Turcotte-Pugh (CTP) do not contain sarcopenia as a variable. For this study, we utilized psoas muscle index (PMI) to objectively determine sarcopenia in hospitalized LC patients, and evaluated it as a predictor of time between discharge and readmission in LC. Abdominal computed tomography and magnetic resonance imaging scans of 65 consecutive LC patients were retrospectively examined to determine PMI. MELD, MELD-Na, and CTP were calculated from clinical data. PMI was then combined with CTP to form an experimental score: CTP sarcopenia (CTPS). For PMI alone and for each score, correlation with time between discharge and readmission for liver-related complications was calculated. PMI was also tested for correlation with sex, body mass index (BMI), MELD, MELD-Na, and CTP. CTPS was most closely correlated with time to readmission (R = 0.730; P < .001), followed by CTP (R = 0.696; P < .001), MELD-Na (R = 0.405; P = .009), and PMI alone (R = 0.388; P = .01). Correlation with MELD (R = 0.354; P = .05) was lowest. Additionally, there were significant differences in PMI between male and female individuals (5.16 vs 4.54 cm2/m2; P = .04) and in BMI between sarcopenic and nonsarcopenic individuals (29.63 vs 25.88 kg/m2; P = .009). Sarcopenia is an independent short-term prognostic factor in LC. By combining data on sarcopenia with CTP, we created an experimental score that predicts time to readmission better than MELD, MELD-Na, or CTP.
Topics: Female; Humans; Male; End Stage Liver Disease; Liver Cirrhosis; Prognosis; Psoas Muscles; Retrospective Studies; ROC Curve; Sarcopenia; Severity of Illness Index; Sodium
PubMed: 36086704
DOI: 10.1097/MD.0000000000030259 -
Annals of Vascular Surgery Apr 2019Sarcopenia is associated with mortality after abdominal aortic aneurysm (AAA) repair. The reliability of computed tomography (CT) core muscle areas and quality-that is,...
BACKGROUND
Sarcopenia is associated with mortality after abdominal aortic aneurysm (AAA) repair. The reliability of computed tomography (CT) core muscle areas and quality-that is, densities and their association with postoperative survival in patients undergoing AAA treatment-were retrospectively studied.
METHODS
Psoas muscle area (PMA) and multifidus area and psoas muscle density (PMD) and multifidus density were measured from CT images and analyzed to lean values. Results were standardized by z-scoring. Measurement reliability was ascertained using intraclass correlation coefficient analysis (3 independent observers). Clinical data were collected from an institutional database and the hospital's patient record database.
RESULTS
The study included 301 patients (89% male, mean age 74.4 years, endovascular treatment 73.1%, rupture 7.6%). Median duration of follow-up was 2.70 (interquartile range 3.54) years and mortality 31.2%. Age, female gender, and body mass index were associated with PMA, PMD, and lean psoas muscle area (LPMA). L3 left PMD, total psoas muscle density, right and left LPMA, lean total psoas muscle area (LTPMA), and L2 right LPMA and LTPMA (hazard ratio 0.74-0.78 per 1 standard deviation, P < 0.05 to P < 0.01) were independently associated with improved survival in multivariable analysis.
CONCLUSIONS
L2-L3 PMD and LPMA are reliable, feasible, and independent predictors of mortality in patients treated for AAA. For every standard deviation increase in these standardized z-score muscle parameters, there was a 22%-26% decrease in the probability of death during follow-up.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortography; Databases, Factual; Female; Health Status; Humans; Male; Multidetector Computed Tomography; Predictive Value of Tests; Psoas Muscles; Reproducibility of Results; Retrospective Studies; Risk Factors; Sarcopenia; Treatment Outcome; Vascular Surgical Procedures
PubMed: 30476615
DOI: 10.1016/j.avsg.2018.08.096 -
Skeletal Radiology Oct 2020CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the...
OBJECTIVE
CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the correlation of psoas muscle mass and quality estimation at L3 with that of hip muscles, which could be opportunistically used in patients undergoing hip surgery.
MATERIALS AND METHODS
Unenhanced abdominal CT performed in 50 patients (29 males, mean/median age 69/72 years) were reviewed. Regions of interest were drawn to assess cross-sectional area (CSA) and attenuation of psoas muscles at L3. These values were correlated with CSA and attenuation of iliopsoas, rectus femoris, sartorius, and tensor fascia latae at the level of the hip, separately on each side. After applying Bonferroni correction for multiple comparisons, statistical significance was set as P < .002.
RESULTS
Attenuation of each psoas at L3 and ipsilateral hip muscles was significantly correlated (P ≤ .001, r = .491-.754). A significant correlation was observed between CSA of right psoas and ipsilateral muscles (P ≤ .00, r = .432-.525). We observed a significant correlation between CSA of left psoas and ipsilateral rectus femoris, iliopsoas, tensor fascia latae at the apex of the femoral head, and sartorius at the level of the lesser trochanter (P ≤ .001, r = .431-.502). Average time to measure CSA and attenuation of psoas muscles at L3 was 41 s, that of hip muscles was 2 min 12 s.
CONCLUSION
Measurements of mass and quality of hip muscles are feasible and correlate to those of psoas muscles at L3, being potentially used in future works on the association of sarcopenia and outcomes after hip surgery.
Topics: Abdominal Muscles; Aged; Hip; Humans; Male; Psoas Muscles; Sarcopenia; Tomography, X-Ray Computed
PubMed: 32476068
DOI: 10.1007/s00256-020-03475-z -
Journal of Geriatric Oncology Jan 2021Comprehensive geriatric assessment (CGA) is used for oncological management in older patients. The evaluation of muscle characteristics is currently not included in the...
OBJECTIVE
Comprehensive geriatric assessment (CGA) is used for oncological management in older patients. The evaluation of muscle characteristics is currently not included in the CGA. This study investigates whether muscle mass and the degree of myosteatosis is associated with mortality in older patients with cancer.
METHODS
CGA was performed in a cohort of older patients with cancer. Cross sectional area (CSA) and mean pixel density (Hounsfield units, HU), as measure for respectively muscle mass and myosteatosis, were obtained from CT images of the psoas muscle at the level of mid L3. Mortality was recorded. Correlation was determined between CSA and HU. Paired sample t-test was used to follow changes in muscle mass and density. Logistic regression was performed to define relevant prognostic factors for mortality.
RESULTS
In total, 183 patients were included (86 male and 97 female), 120 patients (66%) died. Mean age was 80 years (range 70-94 years). Mean days of survival was 606 (range 1-2023). There was a significant correlation between CSA and HU (PCC = 0.196) at time of diagnosis and at follow-up (PCC = 0.257). There was a significant decrease in CSA (p = .008) and HU (p = .004) in men at follow-up. No significant changes were observed in women. In multivariate analysis, a higher gender-corrected CSA was linked to a lower mortality rate with an odds ratio of 0.657 (CI = 0.457-0.944, p = .023). No association was found between HU and mortality.
CONCLUSIONS
Muscle mass correlated with the degree of myosteatosis. CSA and HU tended to decrease during follow-up. Having a greater CSA was prognostic for a lower mortality rate.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Muscle, Skeletal; Neoplasms; Prognosis; Psoas Muscles; Sarcopenia; Tomography, X-Ray Computed
PubMed: 32771287
DOI: 10.1016/j.jgo.2020.06.024 -
Surgery Today Sep 2020An association between the prognoses of trauma and sarcopenia has not been well documented. The purpose of this study was to compare the outcomes of elderly Japanese...
PURPOSE
An association between the prognoses of trauma and sarcopenia has not been well documented. The purpose of this study was to compare the outcomes of elderly Japanese trauma patients with sarcopenia and those without sarcopenia.
METHODS
The medical records of patients aged ≧ 65 years old and Injury Severity Scores above 15 treated for trauma between 2010 and 2017 were reviewed, retrospectively. We measured the psoas muscle index (PMI), defined as the psoas muscle area at the third lumbar vertebra level divided by the body surface area. Patients of each gender with a PMI less than the lower interquartile range were included in the sarcopenia group. A questionnaire was mailed to the patients or their families to collect data on 1-year mortality and activities of daily living.
RESULTS
There were 405 patients included in this study: 304 in the non-sarcopenia group (Group NS) and 101 in the sarcopenia group (Group S). Mortality was significantly higher in Group S than in Group NS (NS; 7.9% vs. S; 15.8%, OR, 2.20; 95% CI, 1.12-4.32; p = 0.027). Only 175 of the questionnaires were completed and the responses did not reveal any significant differences between the groups.
CONCLUSIONS
Sarcopenia as defined by the PMI may be used as an indicator for mortality risk for geriatric trauma patients.
Topics: Age Factors; Aged; Aged, 80 and over; Comorbidity; Female; Forecasting; Humans; Japan; Male; Prognosis; Psoas Muscles; Retrospective Studies; Risk; Sarcopenia; Surveys and Questionnaires; Tomography, X-Ray Computed; Trauma Centers; Trauma Severity Indices; Wounds and Injuries
PubMed: 32124084
DOI: 10.1007/s00595-020-01980-1 -
European Journal of Gastroenterology &... May 2023The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular...
Combination of psoas muscle mass index and neutrophil-to-lymphocyte ratio as a noninvasive prognostic marker in hepatocellular carcinoma patients undergoing radiofrequency ablation.
AIM
The psoas muscle index (PMI) and neutrophil-to-lymphocyte ratio (NLR) have been reported as useful noninvasive prognostic markers in patients with hepatocellular carcinoma (HCC). The usefulness of the combination of the PMI and NLR as a prognostic marker in HCC patients undergoing radiofrequency ablation (RFA) is unclear.
METHODS
We retrospectively analyzed the PMI and NLR in 112 patients undergoing RFA, including 40 patients aged 75 years and older (36%). The influence of the PMI and NLR on disease-free survival and overall survival (OS) was analyzed.
RESULTS
There were 66 patients with high PMI and low NLR values (58%), 36 patients with a low PMI or high NLR value (32%), and 10 patients with low PMI and high NLR values (9%). The combination of the PMI and NLR did not show a significant association with the disease-free survival rate. For patients aged ≥75 years, those with both low PMI and high NLR values showed significantly shorter OS periods (log-rank: P < 0.001). In the multivariate analysis, the combination of a low PMI value and high NLR value was significantly associated with shorter survival periods (hazard ratio: 19.72; 95% confidence interval, 4.933-78.8; P < 0.001).
CONCLUSION
In this study, the combination of PMI and NLR was associated with prognosis in patients with early HCC and preserved liver function. The combination of the PMI and NLR may be a useful and noninvasive prognostic marker in HCC patients aged 75 years and older, as well as in younger patients.
Topics: Humans; Carcinoma, Hepatocellular; Neutrophils; Liver Neoplasms; Prognosis; Retrospective Studies; Psoas Muscles; Lymphocytes; Radiofrequency Ablation
PubMed: 37115983
DOI: 10.1097/MEG.0000000000002532 -
Scientific Reports Oct 2022Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The... (Meta-Analysis)
Meta-Analysis
Sarcopenia is characterised by chronically reduced skeletal muscle volume and function, and is determined radiologically by psoas and skeletal muscle measurement. The present systematic review and meta-analysis aims to examine the relationship between pre-operative CT-derived psoas and skeletal muscle parameters and outcomes in patients undergoing EVAR and F/B-EVAR for aortic aneurysm. The MEDLINE database was interrogated for studies investigating the effect of pre-operative CT-diagnosed sarcopenia on outcomes following EVAR and F/B-EVAR. The systematic review was carried out in accordance with PRISMA guidelines. The primary outcome was overall mortality. RevMan 5.4.1 was used to perform meta-analysis. PROSPERO Database Registration Number: CRD42021273085. Ten relevant studies were identified, one reporting skeletal muscle parameters, and the remaining nine reporting psoas muscle parameters, which were used for meta-analysis. There were a total of 2563 patients included (2062 EVAR, 501 F/B-EVAR), with mean follow-up ranging from 25 to 101 months. 836 patients (33%) were defined as radiologically sarcopenic. In all studies, the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 2.61 (1.67-4.08), p < .001. Two studies reported outcomes on patients undergoing F/B-EVAR; the combined HR for all-cause mortality in sarcopenic versus non-sarcopenic patients was 3.08 (1.66-5.71), p = .004. Radiological sarcopenia defined by psoas or skeletal muscle parameters was associated with inferior survival in patients undergoing both EVAR and F/B-EVAR. Current evidence is limited by heterogeneity in assessment of body composition and lack of a consensus definition of radiological sarcopenia.
Topics: Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Psoas Muscles; Risk Factors; Sarcopenia; Treatment Outcome
PubMed: 36198699
DOI: 10.1038/s41598-022-20490-3 -
The Journal of Experimental Biology Nov 2022The steady-state isometric force produced by skeletal muscle after active shortening and stretching is depressed and enhanced, respectively, compared with purely...
The steady-state isometric force produced by skeletal muscle after active shortening and stretching is depressed and enhanced, respectively, compared with purely isometric force produced at corresponding final lengths and at the same level of activation. One hypothesis proposed to account for these force depression (FD) and force enhancement (FE) properties is a change in cross-bridge cycling kinetics. The rate of cross-bridge attachment (f) and/or cross-bridge detachment (g) may be altered following active shortening and active stretching, leading to FD and FE, respectively. Experiments elucidating cross-bridge kinetics in actively shortened and stretched muscle preparations and their corresponding purely isometric contractions have yet to be performed. The aim of this study was to investigate cross-bridge cycling kinetics of muscle fibres at steady-state following active shortening and stretching. This was done by determining muscle fibre stiffness and rate of active force redevelopment following a quick release-re-stretch protocol (kTR). Applying these measures to equations previously used in the literature for a two-state cross-bridge cycling model (attached/detached cross-bridges) allowed us to determine apparent f and g, the proportion of attached cross-bridges, and the force produced per cross-bridge. kTR, apparent f and g, the proportion of attached cross-bridges and the force produced per cross-bridge were significantly decreased following active shortening compared with corresponding purely isometric contractions, indicating a change in cross-bridge cycling kinetics. Additionally, we showed no change in cross-bridge cycling kinetics following active stretch compared with corresponding purely isometric contractions. These findings suggest that FD is associated with changes in cross-bridge kinetics, whereas FE is not.
Topics: Animals; Rabbits; Isometric Contraction; Muscle Fibers, Skeletal; Mechanical Phenomena; Psoas Muscles; Muscle, Skeletal; Kinetics; Muscle Contraction
PubMed: 36268629
DOI: 10.1242/jeb.244703 -
Internal and Emergency Medicine Mar 2022Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined...
Both quality and quantity of skeletal muscle are considered important for prognostic factors and clinical outcomes in solid cancers. However, few studies have examined both quality and quantity of skeletal muscle in patients with hematological malignancies. The aim of the present study was to clarify the prevalence of low skeletal muscle quantity and quality and their associated factors in patients before allogeneic hematopoietic stem cell transplantation (allo-HSCT). Pretransplant plain CT imaging at the third lumber vertebra level was used to measure the psoas muscle mass index (PMI) and the intramuscular adipose tissue content (IMAC) in 113 adult patients (age 47.1 ± 14.6 years) before HSCT. We analyzed the factors associated with PMI and IMAC, respectively. Although 62.8% of all patients had low skeletal muscle mass, only 8% had poor skeletal muscle quality. Multivariable logistic analysis showed that older age [odds ratio (OR) = 2.45, confidence interval (CI) = 1.04-5.76, P = 0.04], male (OR = 4.35, CI = 0.05-0.97, P = 0.04), and low BMI (OR = 0.83, CI = 0.71-0.97, P = 0.02) were independent risk factors for low PMI before HSCT. Only age (≤ 50 years) was significantly associated with muscle quality (modified OR = 0.07, CI = 0.00-0.43, P < 0.01) in univariate analysis. Most patients already showed low skeletal muscle mass before allo-HSCT although skeletal muscle quality was relatively preserved. These results may be indicative of pre-cachexia and may be useful for its long-term management in allo-HSCT patients.
Topics: Adult; Cachexia; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Prevalence; Psoas Muscles; Retrospective Studies; Risk Factors
PubMed: 34387840
DOI: 10.1007/s11739-021-02828-3 -
PloS One 2021Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating...
BACKGROUND
Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating evidence suggest that low skeletal muscle mass has a negative impact on clinical outcome in elderly adult population. We sought to determine the significance of psoas muscle area as a novel index of low skeletal muscle mass in elderly patients with ADHF.
METHODS
In this single-center retrospective observational study, we reviewed consecutive 865 elderly participants (65 years or older) who were hospitalized for ADHF and 392 were available for analysis (79 years [74-85], 56% male). Cross-sectional areas of psoas muscle at the level of fourth lumbar vertebra were measured by computed tomography and normalized by the square of height to calculate psoas muscle index (PMI, cm2/m2).
RESULTS
Dividing the patients by the gender-specific quartile value (2.47 cm2/m2 for male and 1.68 cm2/m2 for female), we defined low PMI as the lowest gender-based quartile of PMI. Multiple linear regression analysis revealed female sex, body mass index (BMI), and E/e', but not left ventricular ejection fraction, were independently associated with PMI. Kaplan-Meier analysis showed low PMI was associated with higher rate of composite endpoint of all-cause death and ADHF re-hospitalization (P = 0.033). Cox proportional hazard model analysis identified low PMI, but not BMI, was an independent predictor of the composite endpoint (Hazard ratio: 1.52 [1.06-2.16], P = 0.024).
CONCLUSIONS
PMI predicted future clinical adverse events in elderly patients with ADHF. Further studies are needed to assess whether low skeletal muscle mass can be a potential therapeutic target to improve the outcome of ADHF.
Topics: Aged; Aged, 80 and over; Body Mass Index; Cross-Sectional Studies; Female; Heart Failure; Humans; Kaplan-Meier Estimate; Male; Muscle, Skeletal; Prognosis; Proportional Hazards Models; Psoas Muscles; Retrospective Studies
PubMed: 33592068
DOI: 10.1371/journal.pone.0247140