Prognostic Value Of Sarcopenia Research Articles

Prognostic value of sarcopenia in survivors of hematological malignances undergoing a hematopoietic stem cell transplantation: a systematic review and meta-analysis.

Sarcopenia is increasingly recognized as an independent risk factor for poor outcomes in patients undergoing hematopoietic stem cell transplantation (HSCT), and it is a potentially modifiable factor. The purpose of the present systematic review and meta-analysis is to summarize and integrate current evidence in this field. We searched EMBASE, MEDLINE, and Cochrane DSR through Ovid and PubMed websites to identify relevant studies. Studies evaluated sarcopenia before HSCT and reported associations between sarcopenia and post-transplant outcomes were included. Two authors independently applied eligibility criteria, assessed quality, and extracted data. Odds ratio (OR) and their 95% confidence intervals (CIs) were pooled to examine the association between sarcopenia and post-transplant outcomes by using the review manager 5.3 software. Seven retrospective cohort studies met our inclusion criteria. The overall quality of studies was low to moderate. Sarcopenia was associated with higher non-relapse mortality [odds ratio (OR) 1.97; 95% CI 1.45, 2.68; P < 0.0001; I2 = 0%] and shorter overall survival [odds ratio (OR) 0.44; 95% CI 0.26, 0.75; P = 0.002; I2 = 65%] in patients undergoing HSCT. Clinicians could use sarcopenia to balance the risks and benefits of transplantation as early as possible; in addition, interventions can be used to prevent sarcopenia and improve physical function and quality of life. Well-designed, prospective, and large-scale clinical studies are needed to consolidate the evidence.

Preoperatively Identified Sarcopenia Leads to Increased Postoperative Complications, Hospital and ICU Length of Stay in Autologous Microsurgical Breast Reconstruction.

Sarcopenia is a condition characterized by the loss of skeletal muscle mass and strength. Recently, there has been a tremendous amount of research into the prognostic value of sarcopenia in surgical outcomes. The purpose of this study was to compare postoperative outcomes in free flap breast reconstruction in patients with and without sarcopenia. One hundred three patients who underwent autologous breast reconstruction from 2013 to 2016 were studied. The cross-sectional area (CSA) of skeletal muscle was measured from preoperative computed tomography images at L3 using the National Institutes of Health ImageJ software. CSA was then normalized to patient stature by dividing CSA by height (cm2/m2). A previously published skeletal muscle index cutoff of 38.5 cm2/m2 was used to define sarcopenia. Intraoperative and postoperative surgical outcomes were recorded retrospectively. Outcomes were analyzed using multivariate, univariate, and regression statistics. Eight of the 103 (7.8%) patients were found to have sarcopenia. Sarcopenia was associated with a statistically significant increase in flap site delayed healing (37.5% vs. 20%, p = 0.046), take back to the operating room (25% vs. 11.6%, p = 0.05), intensive care unit length of stay (1.5 vs. 0.02 days, p < 0.0005), and hospital length of stay (8.38 vs. 5.49 days, p < 0.0005) when compared with patients without sarcopenia. There were no significant differences in flap loss, surgical site infection, hematoma, seroma, donor site delayed healing, intraoperative complications, and number of revision surgeries. Sarcopenia is significantly associated with increased complications in patients undergoing free flap breast reconstruction. Further investigation into the biochemical and physiologic changes associated with sarcopenia is needed.

Прогностическое значение саркопении у пациентов с ХБП

Прогностическое значение саркопении у пациентов с ХБП

Temporalis Muscle Width as a Measure of Sarcopenia Independently Predicts Overall Survival in Patients with Newly Diagnosed Glioblastoma

Multiple prognostic factors, including age and performance status, are used to determine treatment recommendations in newly diagnosed glioblastoma (GBM). Sarcopenia, or clinically evident muscle wasting, has recently been shown to correlate with shorter overall survival (OS) in patients with newly diagnosed brain metastases. The prognostic value of sarcopenia and the optimal method to evaluate sarcopenia in patients with GBM are unclear. Measurements of the psoas and temporalis muscles have been used to quantify sarcopenia. We sought to develop a method to reproducibly quantify sarcopenia using the temporalis muscle, and evaluate the potential correlation between sarcopenia and outcomes for patients with GBM. We conducted a retrospective analysis of post-operative treatment planning CT simulation scans of 87 newly diagnosed GBM patients from 2012 to 2016. All patients received standard of care chemoradiation therapy including conventionally fractionated radiotherapy to a total dose of 6000 cGy in 30 fractions with concurrent temozolomide. We measured the temporalis muscle width (TMW) bilaterally on four axial CT slices to approximate muscle volume and evaluated the potential correlation between the TMW and OS. Selection of axial slices was defined by bony orbital anatomy: supraorbital, superior quartile (equidistant from supraorbital and mid-orbital), mid-orbital, and inferior quartile (equidistant from mid-orbital and infraorbital) locations. TMW measured on the inferior quartile slice correlated most strongly with OS. TMW was dichotomized at the median measurement (wide, >1.58 cm vs. narrow, ≤1.58 cm). OS for patients with wide TMW (>1.58 cm) was statistically significantly greater than that of patients with narrow TMW (<1.58 cm): 28.3 mo vs 22.2 mo, independent of age, gender, body mass index, Karnofsky Performance Status and resection type ((HR(wide/narrow)=0.42, 95% CI=(0.20, 0.90), adjusted p=0.03). This was especially pronounced in the following patient subsets: females (HR(wide/narrow)=0.26, 95% CI=(0.07, 0.92), p=0.04), and age ≤ 60 years (HR=0.32, 95% CI=(0.13, 0.81), adjusted p=0.02). The temporalis muscle width was used to quantify sarcopenia and found to be independently prognostic of OS in our GBM cohort. Prospective validation of sarcopenia is needed to evaluate its potential in determining optimal patient treatment.

The relationship of sarcopenia in patients undergoing pancreaticoduodenectomy with outcome

Objective To explore the prognostic value of sarcopenia in patients undergoing pancreaticoduodenectomy. Method Clinicopathologic data and follow-up information of 116 patients undergoing pancreaticoduodenectomy at Renmin Hospital of Wuhan University between March 2011 and August 2016 were collected for statistical analysis. Results Among the 116 patients, the prevalence of sarcopenia was 42.2% (n=49). When compared to the rest of the patients who did not have sarcopenia, the sarcopenia group had longer recovery time [(17.33±6.54)d vs. (13.46±9.32)d, P=0.013] and increased risk of complications (complications in general, 59.2% vs. 38.8%, χ2=4.714, P=0.030; Clavien-Dindo≥3: 26.5% vs. 10.4%, χ2=5.130, P=0.024). Both the Kaplan-Meier survival analysis (P<0.05) and the Cox proportional hazard model (overall survival: hazard ratio=2.285, 95% CI=1.521-3.431; recurrence-free survival, hazard ratio=2.167, 95% CI=1.445-3.248) indicated sarcopenia as the risk factor for poorer overall survival and recurrence-free survival. Conclusions Sarcopenia was an independent predictor of poor prognosis for patients undergoing pancreaticoduodenectomy. Patients with sarcopenia had higher risk of developing complications after surgery and lower overall survival rate and recurrence-free survival rate. Key words: Sarcopenia; Pancreaticoduodenectomy; Complications; Overall survival; Recurrence-free survival

Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis.

BackgroundSarcopenia is a common syndrome in chronic diseases such as liver cirrhosis. The association between sarcopenia and outcomes, such as complications and survival has recently been described in various patient groups. However, study results remain inconclusive. Therefore, the aim of this study was to systematically review the impact of sarcopenia on outcome in patients with cirrhosis.Methods and findingsWe conducted a systematic review (SR) and meta-analysis (MA) on the impact of sarcopenia on outcome in liver cirrhosis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Of the 312 studies identified, 20 were eligible according to our inclusion criteria. Most of the studies used CT to diagnose sarcopenia. Two studies used bioelectrical impedance analysis (BIA), 10 studies used skeletal muscle index (SMI) and 8 studies used total psoas muscle area (TPA). Seven studies included Asian participants and the remaining 13 studies included Western participants. The prevalence rate of sarcopenia among participants was mean 48.1%, and appeared more among men with a rate of 61.6% whereas the rate was 36% for women. With respect to clinical outcomes, patients with sarcopenia had poorer survival rates and an increased risk of complications such as infection compared to those without sarcopenia. According to the analysis of race subgroup, Asians had a HR 2.45 (95% confidence interval (CI) = 1.44–4.16, P = 0.001) of mortality whereas Westerners had a HR 1.45 (95% CI = 1.002–2.09, P<0.05).ConclusionsBased on this SR and MA, the presence of sarcopenia is related to a poor prognosis and occurrence of cirrhotic complications and could be used for risk assessment. Moreover, Asian participants had higher mortality related to sarcopenia compared to the Western participants.

Sarcopenia: Prevalence and Prognostic Implications in Elderly Patients with Cardiovascular Disease

AbstractAimsSarcopenia has recently been given an ICD‐10 code. However, there have been no systematic investigations regarding the prevalence or prognostic value of sarcopenia in cardiovascular disease (CVD) according to the international consensus definition. The present study was performed to investigate the prevalence and prognostic value of sarcopenia in elderly patients with CVD.Methods and resultsThe study population consisted of 1603 admitted patients aged ≥ 65 years (74.4 ± 6.2 years, 1049 men) with CVD. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia. The endpoint for the study was all‐cause mortality. The overall sarcopenia prevalence rate was 29.7% (19.6% in men and 48.7% in women). The prevalence rates of sarcopenia across major diagnostic categories were as follows: acute coronary syndrome, 17.8%; post‐cardiac surgery, 31.8%; and heart failure, 35.2%. During the 2.3 ± 2.1‐year follow‐up period, 175 deaths occurred. Patients with sarcopenia showed higher risk of all‐cause mortality compared with non‐sarcopenic patients (adjusted hazard ratio: 1.44; 95% confidence interval: 1.01 – 2.05; P = 0.044).ConclusionsSarcopenia is highly prevalent among elderly patients with CVD and is associated with increased mortality risk.

SARCOPENIA: PREVALENCE AND PROGNOSIS IN OLDER PATIENTS WITH CARDIOVASCULAR DISEASE

To date, no study has systematically investigated the prevalence of sarcopenia in cardiovascular disease (CVD) according to the international consensus definition. The aim of this study was to investigate the prevalence and prognostic value of sarcopenia in older patients with CVD. The study population consisted of 1929 admitted patients aged 60 years and older (72.3 ± 7.3 years, 633 females) with CVD. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). Handgrip strength was measured with a handheld dynamometer, and gait speed was measured by a 10-m walking test. Using the cut-off points from the AWGS consensus, low hand grip strength was defined as <26 kg for men and <18 kg for women, and slow gait speed was defined as <0.8 m/sec. The muscle mass was estimated according to a previously validated anthropometric equation in Asian population. The endpoint was all-cause mortality. The prevalence of sarcopenia was 26.8% (male:17.6%, female:45.7%) and increased with age (<75 years: 16.5%, 75–84 years: 40.3%, ≥85 years: 62.6%, P for trend <0.001). During follow-up (2.3 ± 2.2years), 203 deaths occurred. Patients with sarcopenia had a higher risk of all-cause death compared with non-sarcopenic patients (age-sex adjusted hazard ratio: 2.00, 95% confidence interval: 1.46 - 2.73, P < 0.001). The present study suggests that sarcopenia is highly prevalent among older patients with CVD and it is associated with increased mortality.

Prognostic value of sarcopenia in liver surgery

Current knowledge indicates that malnutrition increases the rate of post-operative complications, particularly respiratory and infectious, after major surgery. Almost all liver surgery is performed in patients with cancer, a factor that increases the risk of malnutrition. The primary risk factors for post-operative complications are pre-operative hypo-albuminemia and a body mass index less than 20 kg/m(2). To improve the prediction of complications in these patients, some teams have suggested measurement of muscle thickness by computed tomography. Muscular mass can thus be quantified by measuring the total surface of the psoas muscle or the total surface of all muscles (i.e. external and internal oblique, transverse, psoas and paravertebral muscles) seen on an axial CT slice at L3. As well, data exist suggesting that sarcopenia is an independent predictive factor of post-operative morbidity and poor long-term survival after resection for cancer. Nonetheless, the literature on the subject is limited, there are no standardized definitions for sarcopenia, and the need of special software to calculate the surfaces limits its usefulness. Lastly, there are little if any data concerning the nutritional or pharmacologic means to treat sarcopenia. This update, based on a literature review, deals with the value and the prognostic impact of sarcopenia in surgery for liver tumors. The current definition of sarcopenia, validated internationally, the methods of measurement, and the consequences of sarcopenia on the outcome of liver resections are detailed in this review.

Sarcopenia and mortality among a population-based sample of community-dwelling older adults.

BackgroundSarcopenia is a risk‐factor for all‐cause mortality among older adults, but it is unknown if sarcopenia predisposes older adults to specific causes of death. Further, it is unknown if the prognostic role of sarcopenia differs between males and females, and obese and non‐obese individuals.MethodsA population‐based cohort study among 4425 older adults from the Third National Health and Nutrition Survey (1988–1994). Muscle mass was quantified using bioimpedance analysis, and muscle function was quantified using gait speed. Multivariable‐adjusted Cox regression analysis examined the relationship between sarcopenia and mortality outcomes.ResultsThe mean age of study participants was 70.1 years. The prevalence of sarcopenia was 36.5%. Sarcopenia associated with an increased risk of all‐cause mortality [hazard ratio (HR): 1.29 (95% confidence interval (95% CI): 1.13–1.47); P < 0.001] among males and females. Sarcopenia associated with an increased risk of cardiovascular‐specific mortality among females [HR: 1.61 (95% CI: 1.22–2.12); P = 0.001], but not among males [HR: 1.07 (95% CI: 0.81–1.40; P = .643); P interaction = 0.079]. Sarcopenia was not associated with cancer‐specific mortality among males and females [HR: 1.07 (95% CI: 0.78–1.89); P = 0.672]. Sarcopenia associated with an increased risk of mortality from other causes (i.e. non‐cardiovascular and non‐cancer) among males and females [HR: 1.32 (95% CI: 1.07–1.62); P = 0.008]. Obesity, defined using body mass index (P interaction = 0.817) or waist circumference (P interaction = 0.219) did not modify the relationship between sarcopenia and all‐cause mortality.ConclusionsSarcopenia is a prevalent syndrome that is associated with premature mortality among community‐dwelling older adults. The prognostic value of sarcopenia may vary by cause‐specific mortality and differ between males and females.