Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

Abstract

BackgroundVarious body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis.MethodsSubjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables.ResultsThe cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm2/m2 for males and 2.89 cm2/m2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257).ConclusionsPMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer

“…We undertook a similar method to previous studies which included measuring a standardized form of psoas muscle area and defining sarcopenia as those patients falling into the lowest tertile [47]. Additionally, we are confident that our cohort has a similar body composition profile when compared to healthy patients as our lowest tertile PMI cutoffs in females (4.11) and in males (5.37) were comparable to previous studies [26].…”

“…This technique is consistent with previously published similar methodology. [21,[26][27][28] Once the muscle was outlined accurately, an automatic calculation of the area of pixels with attenuation between − 29 and 150 Hounsfield units (HU) was performed (Fig. 1).…”

Risk Factors of Gastrointestinal Perforation with a Poor Prognosis

“…In Kayano's study, hospitalization duration was shorter in the high psoas muscle index (PMI) group than in the low PMI group. 23 As a nutrient storage system, muscles utilized amino acids to combat inflammation during a bacterial invasion. Similar to Kayano's study, but with different nutrient indices for total protein and hemoglobin, our outcome was comparable.…”

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

“…Radiological sarcopenia can be a quantitative surrogate representation of physiological reserve in patients, providing valuable information on the hurdles to recovery. This is most commonly represented by psoas muscle index (PMI), [2][3][4][5][6][7][8][9][10]19,50 skeletal muscle index (SMI) 11,12,14,17,50 and PM:L3. 1,10,[18][19][20] However, SMI and PMI both require either the patients' height or their body surface areawhich are less practical to obtain in an emergency situation with a deteriorating patient.…”

“…Sarcopenia has been recognized as one of the key elements of frailty and is associated with poorer surgical outcomes. Pre‐operative sarcopenia as measured with CT data has been consistently demonstrated to be associated with higher post‐operative mortality after EL, 1–20 and further verified in systematic reviews and meta‐analyses 21–24 . One of the reported ways to quantify sarcopenia is via analysis of CT scans to measure the ratio of the cross‐sectional area of psoas muscle to the area of the L3 vertebral body.…”