Early decrease in erector spinae muscle area and future risk of mortality in idiopathic pulmonary fibrosis

Akiko Nakano,Akio Niimi,Hiroyuki Taniguchi,Hirotsugu Ohkubo,Mitsuaki Yagi,Yasuhiro Kondoh,Toshiaki Matsuda,Taiki Furukawa,Yoshihiro Kanemitsu

doi:10.1038/s41598-020-59100-5

Abstract

Computed tomography (CT) assessment of the cross-sectional area of the erector spinae muscles (ESMCSA) can be used to evaluate sarcopenia and cachexia in patients with lung diseases. This study aimed to confirm whether serial changes in ESMCSA are associated with survival in patients with idiopathic pulmonary fibrosis (IPF). Data from consecutive patients with IPF who were referred to a single centre were retrospectively reviewed. We measured the ESMCSA at the level of the 12th thoracic vertebra on CT images at referral and 6 months later (n = 119). The follow-up time was from 817–1633 days (median, 1335 days) and 59 patients (49.6%) died. A univariate Cox regression analysis showed that the decline in % predicted forced vital capacity (FVC) (Hazard ratios [HR] 1.041, 95% confidence interval [CI] 1.013–1.069, P = 0.004), the decline in body mass index (BMI) (HR 1.084, 95% CI 1.037–1.128; P < 0.001) and that in ESMCSA (HR 1.057, 95% CI 1.027–1.086; P < 0.001) were prognostic factors. For multivariate analyses, the decline in ESMCSA (HR 1.039, 95% CI 1.007–1.071, P = 0.015) was a significant prognostic factor, while those in % FVC and BMI were discarded. Early decrease in ESMCSA may be a useful predictor of prognosis in patients with IPF.

Highlights

Computed tomography (CT) assessment of the cross-sectional area of the erector spinae muscles (ESMCSA) can be used to evaluate sarcopenia and cachexia in patients with lung diseases
Variable Total, n Age, years Sex, Female, n (%) Never smoker, n (%) Ex-smoker, n (%) Current smoker, n (%) Smoking history, pack-years Body mass index, kg/m2 Biopsy-proven idiopathic pulmonary fibrosis (IPF), n (%) forced vital capacity (FVC), % predicted forced expiratory volume in 1 second (FEV1)/FVC, % DLCO, % predicted* Distance walked during 6 minute walk test (6MWT), m Lowest SpO2 during 6MWT, % ESMCSA, cm[2]
The clinical characteristics and ESMCSA of 144 patients at baseline, 119 patients who underwent high resolution computed tomography (HRCT) after 6 months, and 25 patients who did not undergo HRCT after 6 months are shown in Supplemental Table 1

Summary

Introduction

Computed tomography (CT) assessment of the cross-sectional area of the erector spinae muscles (ESMCSA) can be used to evaluate sarcopenia and cachexia in patients with lung diseases. It is associated with underlying diseases and is characterised by loss of muscle with or without loss of fat mass in cancer and chronic diseases such as congestive heart failure, chronic kidney disease and chronic obstructive pulmonary disease (COPD)[17,18]. Assessment of the cross-sectional area of the erector spinae muscles (ESMCSA) from chest computed tomography (CT) scans has been used to evaluate sarcopenia and cachexia in patients with chronic lung disease[21,22]. ESMCSA is decreased in patients with IPF, idiopathic pleuroparenchymal fibroelastosis (iPPEE) and chronic obstructive pulmonary disease (COPD)[21,22]. Suzuki et al revealed that a smaller ESMCSA in patients with IPF was associated with a poor prognosis[22]

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