Psoas muscle index and psoas muscle density as predictors of mortality in patients undergoing hemodialysis

Yajima, Takahiro; Arao, Maiko; Yajima, Kumiko

doi:10.1038/s41598-022-14927-y

Cited by 18 publications

(7 citation statements)

References 37 publications

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“…Skeletal muscle mass and quality can be assessed by cross‐sectional skeletal muscle area and skeletal muscle density 11 . Yajima et al found that CT‐measured lower psoas muscle index and lower psoas muscle density at L3 were independently associated with an increased risk of all‐cause mortality in patients undergoing HD (>6 months) 32 . Recently, some studies found that muscle density instead of muscle mass may represent a more clinically meaningful surrogate of muscle function 13,33 .…”

Section: Discussionmentioning

confidence: 99%

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Sheng,

Cao,

Hou

et al. 2023

J cachexia sarcopenia muscle

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BackgroundSkeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have suggested a correlation between CT‐determined skeletal muscle mass and quality at the first lumbar vertebra (L1) level and adverse outcomes. Generally, chest CT does not reach beyond L1. We aimed to determine whether opportunistic CT scan (chest CT)‐determined skeletal muscle mass and quality at L1 are associated with mortality in initial‐dialysis patients.MethodsThis 3‐year multicentric retrospective study included initial‐dialysis patients from four centres between 2014 and 2017 in China. Unenhanced CT images of the L1 and L3 levels were obtained to assess skeletal muscle mass [by skeletal muscle index, (SMI), cm2/m2] and quality [by skeletal muscle density (SMD), HU]. Skeletal muscle measures at L1 were compared with those at L3. The sex‐specific optimal cutoff values of L1 SMI and L1 SMD were determined in relation to all‐cause mortality. The outcomes were all‐cause death and cardiac death. Cox regression models were applied to investigate the risk factors for death.ResultsA total of 485 patients were enrolled, of whom 257 had both L1 and L3 images. Pearson's correlation coefficient between L1 and L3 SMI was 0.84 (P < 0.001), and that between L1 and L3 SMD was 0.90 (P < 0.001). No significant association between L1 SMI and mortality was observed (P > 0.05). Low L1 SMD (n = 280, 57.73%) was diagnosed based on the optimal cutoff value (<39.56 HU for males and <33.06 HU for females). Multivariate regression analysis revealed that the low L1 SMD group had higher risks of all‐cause death (hazard ratio 1.80; 95% confidence interval 1.05–3.11, P = 0.034) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007).ConclusionsIn initial‐dialysis patients, there is high agreement between the L1 and L3 measures for SMI and SMD. Low SMD measured at L1, but not low SMI, is an independent predictor of both all‐cause death and cardiac death.

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Section: Discussionmentioning

confidence: 99%

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Sheng,

Cao,

Hou

et al. 2023

J cachexia sarcopenia muscle

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“…Using CT muscle density as a surrogate of muscle quality is advantageous for several reasons: it is objective, independent of patient volition, and accessible to all patients who receive a CT scan, regardless of their cognitive, mobility, or conscious status. Muscle density is also predictive of survival in many clinical populations, including heart failure, 21,22 cancer, 3,23,24 COVID-19, 25 and many others 2,26–30 . Before CT muscle density can be effectively utilized as a method of diagnosing muscle wasting diseases and predicting survival, cut points for healthy muscle density must be established and be applicable to contrast and NC exams.…”

Section: Discussionmentioning

confidence: 99%

“…Muscle density is also predictive of survival in many clinical populations, including heart failure, 21,22 cancer, 3,23,24 COVID-19, 25 and many others. 2,[26][27][28][29][30] Before CT muscle density can be Each correction was applied to arterial data (middle column), venous data, (right column), or both. Differences between corrected contrast scan densities and non-contrast scan densities are shown in HU with 95% CIs in parentheses.…”

Section: Discussionmentioning

confidence: 99%

Correcting Posterior Paraspinal Muscle Computed Tomography Density for Intravenous Contrast Material Independent of Sex and Vascular Phase

Lortie,

Rush,

Gage

et al. 2023

Journal of Thoracic Imaging

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Purpose: Intravenous contrast poses challenges to computed tomography (CT) muscle density analysis. We developed and tested corrections for contrast-enhanced CT muscle density to improve muscle analysis and the utility of CT scans for the assessment of myosteatosis. Materials and Methods: Using retrospective images from 240 adults who received routine abdominal CT imaging from March to November 2020 with weight-based iodine contrast, we obtained paraspinal muscle density measurements from noncontrast (NC), arterial, and venous-phase images. We used a calibration sample to develop 9 different mean and regression–based corrections for the effect of contrast. We applied the corrections in a validation sample and conducted equivalence testing. Results: We evaluated 140 patients (mean age 52.0 y [SD: 18.3]; 60% female) in the calibration sample and 100 patients (mean age 54.8 y [SD: 18.9]; 60% female) in the validation sample. Contrast-enhanced muscle density was higher than NC by 8.6 HU (SD: 6.2) for the arterial phase (female, 10.4 HU [SD: 5.7]; male, 6.0 HU [SD:6.0]) and by 6.4 HU [SD:8.1] for the venous phase (female, 8.0 HU [SD: 8.6]; male, 4.0 HU [SD: 6.6]). Corrected contrast-enhanced and NC muscle density was equivalent within 3 HU for all correctionns. The −7.5 HU correction, independent of sex and phase, performed well for arterial (95% CI: −0.18, 1.80 HU) and venous-phase data (95% CI: −0.88, 1.41 HU). Conclusions: Our validated correction factor of −7.5 HU renders contrast-enhanced muscle density statistically similar to NC density and is a feasible rule-of-thumb for clinicians to implement.

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“…A common element of PEW and sarcopenia is muscle wasting or loss of muscle; therefore, hemodialysis patients can concomitantly have PEW and sarcopenia [3,4]. We recently reported that computed tomography-measured sarcopenic indices are promising indicators of mortality in hemodialysis patients [12][13][14][15]. According to the Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment, muscle function, such as muscle strength, is considered more important than muscle mass for predicting sarcopenia and mortality in the general population [10].…”

Section: Introductionmentioning

confidence: 99%

Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving hemodialysis

Yajima

Yajima²

2023

PLoS ONE

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The bioelectrical impedance analysis-measured ratio of extracellular water (ECW) to intracellular water (ICW) reflects fluid volume and malnutrition. It may be an indicator of protein-energy wasting and muscle wasting in hemodialysis patients. We examined the association between the ECW/ICW ratio and simplified creatinine index, which is a new surrogate marker of protein-energy wasting and muscle wasting, and whether their combination can accurately predict mortality. A total of 224 patients undergoing hemodialysis for more than 6 months and having undergone bioelectrical impedance analysis for the assessment of body composition were included. Patients were divided into two groups based on the cut-off values of the ECW/ICW ratio (0.57) and simplified creatinine index (20.4 mg/kg/day) for maximumly predicting mortality. Thereafter, they were cross-classified into four groups with each cut-off point. The ECW/ICW ratio was independently associated with the simplified creatinine index (β = -0.164; P = 0.042). During a follow-up of 3.5 years (2.0–6.0 years), 77 patients died. A higher ECW/ICW ratio (adjusted hazard ratio, 3.66, 95% confidence interval 1.99–6.72, P <0.0001) and lower simplified creatinine index (adjusted hazard ratio, 2.25, 95% confidence interval 1.34–3.79, P = 0.0021) were independently associated with an increased risk of all-cause mortality. The adjusted hazard ratio for the higher ECW/ICW ratio and lower simplified creatinine index group vs. the lower ECW/ICW ratio and higher simplified creatinine index group was 12.22 (95% confidence interval 3.68–40.57, p <0.0001). Furthermore, the addition of the ECW/ICW ratio and simplified creatinine index to the baseline risk model significantly improved the C-index from 0.831 to 0.864 (p = 0.045). In conclusion, the ECW/ICW ratio may be a surrogate marker of muscle wasting. Moreover, combining the ECW/ICW ratio and simplified creatinine index may improve the accuracy of predicting all-cause mortality and help stratify the mortality risk of hemodialysis patients.

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Psoas muscle index and psoas muscle density as predictors of mortality in patients undergoing hemodialysis

Cited by 18 publications

References 37 publications

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China

Correcting Posterior Paraspinal Muscle Computed Tomography Density for Intravenous Contrast Material Independent of Sex and Vascular Phase

Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving hemodialysis

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