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.
Highlights
Various body composition indices have been reported as prognostic factors for different cancers
In terms of body composition, psoas muscle index (PMI), VAR, and psoas muscle attenuation (PMA) were higher in males than in females, but subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI) were higher in females than in males (Table 1)
The severity of lower gastrointestinal perforation is considered to involve a large number of prognostic factors, and a scoring system is considered important for judging the preoperative condition more comprehensively
Summary
Various body composition indices have been reported as prognostic factors for different cancers. 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 and quickly from computed tomography (CT) are useful for predicting prognosis. Perforation of the lower gastrointestinal tract is a pathological condition that can result in severe bacterial infection and subsequent septic shock due to fecal peritonitis. As this condition increases in severity, disseminated intravascular coagulation (DIC) can arise and fall into multiple organ failure, sometimes leading to death. The purpose of this study was to clarify whether somatic composition affects the prognosis of lower gastrointestinal perforation
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