Prognostic Value of Psoas Muscle Area and Density in Patients Who Undergo Cardiovascular Surgery

Yamashita, Masashi; Kamiya, Kentaro; Matsunaga, Atsuhiko; Kitamura, Tadashi; Hamazaki, Nobuaki; Matsuzawa, Ryota; Nozaki, Kohei; Tanaka, Shinya; Nakamura, Takeshi; Maekawa, Emi; Masuda, Takashi; Ako, Junya; Miyaji, Kagami

doi:10.1016/j.cjca.2017.10.009

Cited by 75 publications

(49 citation statements)

References 40 publications

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“…13 The psoas muscle density (PMD) was defined as the mean muscle attenuation in Hounsfield units (HU). 14 The CT scans were assessed by two observers. We analyzed 10 different randomly chosen patients to assess the agreements of the two observers by using intraclass correlation coefficients (ICC).…”

Section: Ct Image Analysis and Ct-determined Sarcopenia Definitionmentioning

confidence: 99%

<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

Xu¹,

Li²,

Zhang³

et al. 2020

RMHP

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Background and Aim: Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD. Patients and Methods: We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cutoff values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed. Results: The optimal cutoff values of TPAI were 4.78 cm 2 /m 2 for males and 3.46 cm 2 /m 2 for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAIdefined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications. Conclusion: Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cutoff values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.

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Section: Ct Image Analysis and Ct-determined Sarcopenia Definitionmentioning

confidence: 99%

<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

Xu¹,

Li²,

Zhang³

et al. 2020

RMHP

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“…Furthermore, lipids can be stored within skeletal muscle when the capacity for fat storage by subcutaneous and visceral tissue are exceeded, known as intramuscular fat (IMF) tissue (14). IMF deposition not only reflects the quality of muscle and poor physical function, it is also an independent risk factor for prognosis after cardiac and oncologic surgery (16‐19).…”

Section: Introductionmentioning

confidence: 99%

Visceral Adiposity and High Intramuscular Fat Deposition Independently Predict Critical Illness in Patients with SARS‐CoV‐2

Yang

Ding

Zou

et al. 2020

Obesity

103

143

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Objective This study aimed to assess the association between adipose tissue distribution and severity of clinical course in patients with severe acute respiratory syndrome coronavirus 2. Methods For this retrospective study, 143 hospitalized patients with confirmed coronavirus disease 2019 (COVID‐19) who underwent an unenhanced abdominal computed tomography (CT) scan between January 1, 2020, and March 30, 2020, were included. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the severity of COVID‐19 infection. Results There were 45 patients who were identified as critically ill. High visceral to subcutaneous adipose tissue area ratio (called visceral adiposity) (odds ratio: 2.47; 95% CI: 1.05‐5.98, P = 0.040) and low mean attenuation of skeletal muscle (called high intramuscular fat [IMF] deposition) (odds ratio: 11.90; 95% CI: 4.50‐36.14; P < 0.001) were independent risk factors for critical illness. Furthermore, visceral adiposity or high IMF deposition increased the risk of mechanical ventilation (P = 0.013, P < 0.001, respectively). High IMF deposition increased the risk of death (P = 0.012). Conclusions COVID‐19 patients with visceral adiposity or high IMF deposition have higher risk for critical illness. Therefore, patients with abdominal obesity should be monitored more carefully when hospitalized.

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“…Calculation of psoas density may be a more accurate method of determining sarcopenia than psoas area, as variable fat content of the skeletal muscle may increase cross-sectional area confounding the measurement of lean muscle area and does not require standardisation for height and weight [ 8 ]. Psoas density better predicted poor outcomes compared to cross-sectional area in a cohort of trauma patients [ 9 ], a cohort having pancreatectomy [ 10 ], a cohort of patients having cardiac surgery [ 11 ] and patients having an emergency laparotomy [ 12 ]. However, most studies used software separate to the main imaging viewing and reporting software.…”

Section: Introductionmentioning

confidence: 99%

Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection

et al. 2019

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Background Radiologically defined sarcopenia has been shown to predict negative outcomes after cancer surgery, however radiological assessment of sarcopenia often requires additional software and standardisation against anthropomorphic data. Measuring psoas density using hospital Picture Archiving and Communication Systems (PACS), universally available in the UK, may have advantages over methods requiring the use of additional specialist and often costly software. The aim of this study was to assess the association between radiologically defined sarcopenia measured by psoas density and postoperative outcome in patients having a colorectal cancer resection. Methods All patients having a resection for colorectal cancer, discussed by the colorectal multi-disciplinary team in one institution between 1/1/15 and 31/12/15, were retrospectively identified. Mean psoas density at the level of the L3 vertebra was analysed from preoperative computed tomography (CT) scans to define sarcopenia using the Picture Archiving and Communication Systems (PACS). Postoperative complications and mortality were recorded. Results One hundred and sixty-nine patients had a colorectal resection for cancer and 140 of these had a primary anastomosis. Ninety-day mortality and 1-year mortality were 1.1% and 7.1%, respectively. Eighteen (10.7%) patients suffered a Clavien–Dindo grade 3 or 4 complication of which 6 (33%) were anastomotic leaks. In the whole cohort, sarcopenia was associated with an increased risk of Clavien–Dindo grade 3 or 4 complications [adjusted OR 6.33 (1.65–24.23) p = 0.007]. In those who had an anastomosis, sarcopenia was associated with an increased risk of anastomotic leak [adjusted OR 14.37 (1.37–150.04) p = 0.026]. Conclusions A quick and easy radiological assessment of sarcopenia by measuring psoas density on preoperative CT scan using software universally available in the UK is highly predictive of postoperative morbidity in colorectal cancer patients.

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Prognostic Value of Psoas Muscle Area and Density in Patients Who Undergo Cardiovascular Surgery

Cited by 75 publications

References 40 publications

<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

<p>Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy</p>

Visceral Adiposity and High Intramuscular Fat Deposition Independently Predict Critical Illness in Patients with SARS‐CoV‐2

Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection

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