Prevalence of Sarcopenia and Its Effect on Postoperative Complications in Patients with Crohn’s Disease

Abstract

Background and Aims. Sarcopenia is a prognostic factor of outcomes for various diseases, but reports on sarcopenia in patients with Crohn’s disease (CD) are few. We aim to determine the prevalence of sarcopenia and assess the role of sarcopenia in postoperative complications in patients with CD at a tertiary referral center. Methods. Patients who underwent intestinal surgery for CD from January 2013 to October 2019 were retrospectively enrolled. The L3 skeletal muscle mass index (SMI) was used to identify sarcopenia. Demographic data, preoperative laboratory data, surgical details, and hospital outcomes were recorded. The factors associated with postoperative complications were evaluated through univariate and multivariate analyses. Results. One hundred and twenty-four patients were enrolled. Thirty-four of them (27.4%), including 11 males, were diagnosed with sarcopenia. Compared with patients without sarcopenia, sarcopenic patients had a significantly lower BMI ( P < 0.001 ); lower preoperative serum albumin ( P = 0.006 ), prealbumin ( P = 0.030 ), and hemoglobin levels ( P < 0.001 ); longer hospital stay ( 34.4 ± 26.8 days vs. 22.8 ± 15.6 days, P = 0.003 ); and more occurrences of complications (41.2% vs. 23.3%, P = 0.049 ). The overall incidence of postoperative complications was 28.2%. Infection (51.4%) and intestinal fistula (22.9%) were the most common among such complications. Through the multivariate analysis, sarcopenia was identified as an independent risk factor for major postoperative complications ( odds ratio = 3.974 , 95 % CI = 1.171 –13.489, P = 0.027 ). Conclusion. Sarcopenia is common in patients with CD requiring bowel resection, and it significantly increases the risk of major postoperative complications.

Preoperative Prognostic Nutritional Index and Nomogram for Predicting the Risk of Postoperative Complications in Patients With Crohn's Disease

“…It seemed that PNI was a better prognostic factor to predict postoperative complications of patients with CD. We also found that myopenia was an independent predictor of postoperative complications, which was consistent with our previous study ( 25 ).…”

Factors associated with low skeletal muscle index among patients with Crohn’s disease

“…Previous research had suggested that muscle loss was higher in males than females 11 . Sarcopenia was considered to be an age-related disease 2 . However, for CD patients with disease-related muscle loss, there was no statistical difference in age between the low and normal skeletal muscle groups.…”

“…The bone and skeletal muscle are vulnerable to be affected by the disease. Low muscle mass has been proven to be associated with adverse outcomes including the severity of CD, the presence of surgery related to CD, increase in the intestinal surgery-associated complications, and death 2 , 3 . CT is considered the gold standard technique for the detection of muscle quality and accurate assessment of body composition in patients with CD 4 .…”

Strong impact of sarcopenic state defined by skeletal muscle mass index on postoperative complication of Crohn's disease patients

“…Galata et al obtained a sarcopenia prevalence of 70.4 % in 162 CD patients and proposed that the cut-off value for risk of postoperative adverse events should be an SMI of <41.5 cm 2 /m 2 in males and SMI of <31.8 cm 2 /m 2 in female patients as calculated by abdominal CT or MRI [ 11 ]. Zhang et al reported that the prevalence of sarcopenia was 27.4 % in 124 CD patients according to the cut-off previously reported by Martin et al [ 32 ], which is SMI <41 cm 2 /m 2 in females, SMI <43 cm 2 /m 2 in males with BMI <25 kg/m 2 , and SMI <53 cm 2 /m 2 in males with BMI ≥25 kg/m 2 [ 33 ]. These cut-off values of sarcopenia were useful to detect CD patients at higher risk of postoperative complication, but the data was mostly derived from patients of a Western genetic background.…”