Psoas Index Research Articles

The relationship between sarcopenia and survival at 1\xa0year in patients having elective colorectal cancer surgery

BackgroundColorectal cancer remains a common cause of cancer death in the UK, with surgery being the mainstay of treatment. An objective measurement of the suitability of each patient for surgery, and their risk–benefit calculation, would be of great utility. We postulate that sarcopenia (low muscle mass) could fulfil this role as a prognostic indicator. The aim of this study was to determine the relationship between sarcopenia and long-term outcomes in patients undergoing elective bowel resection for colorectal cancer.MethodsOne hundred and sixty-three consecutive patients who had elective curative colorectal resection for cancer were eligible for inclusion in the study. Psoas muscle mass was assessed on preoperative computed tomography scan at the level of the L3 vertebra and standardised for patient height (total psoas index, TPI). Sarcopenia (low muscle mass) was defined as < 524 mm2/m2 in males and 385 mm2/m2 in females. In addition to clinical–pathological parameters, postoperative complications were recorded and patients were followed up for mortality for 1 year after surgery.ResultsSarcopenia was present in 19.6% of the study participants and was significantly related to body mass index (p = 0.007), 30-day mortality (p = 0.042) and 1-year mortality (p = 0.046). In univariate analysis, American Society of Anesthesiologists grade (p = 0.016), tumour stage (p = 0.018) and sarcopenia (p = 0.043) were found to be significant independent predictors of 1-year mortality.ConclusionsThis study has found sarcopenia to be prevalent in patients with colorectal cancer having elective surgery. Independent of age, sarcopenia was associated with poorer 30-day mortality and survival at 1 year. Measurement of muscle mass preoperatively could be used to stratify a patient’s risk, allowing targeted strategies such as prehabilitation, to be implemented to modify sarcopenia and improve long-term outcomes for patients.

MON-PO479: Evaluation of Sarcopenia Through the Psoas Index in Patients Submitted to Digestive Tract Surgery at Hospital Do Servidor Público Estadual de São Paulo, Brazil

MON-PO479: Evaluation of Sarcopenia Through the Psoas Index in Patients Submitted to Digestive Tract Surgery at Hospital Do Servidor Público Estadual de São Paulo, Brazil

Abstract 4004: Unique patient signatures underlie health disparities in ethnically diverse patients with pancreatic cancer

Abstract Introduction: Health disparities in pancreatic cancer (PC) exist but how the underlying biology contributes to this is poorly described. Black Americans have a higher prevalence, present with more advanced disease, and suffer from higher mortality rates than other ethnic groups. Cancer cachexia, or cancer-associated muscle wasting, affects more than 80% of patients with PC. Unique muscular characteristics exist in different ethnic groups which might be contributing to pancreatic cancer health disparities. We hypothesize that Black patients with PC have a distinct muscular profile and are more affected by cancer cachexia than Whites and that unique genomic variations might contribute to this phenomenon in PC tumors between Black and White patients. Methods: Black (including African Americans and Afro-Caribbeans) and non-Hispanic White surgically resected patients with PC between 2010 and 2017 were case matched by age, gender, and tumor grade. Muscular indices were measured from CT scans by dividing the area of the psoas muscles by the L3 vertebral body area to normalize for patient size. Whole-exome sequencing was performed on DNA from tumor and adjacent benign parenchyma. Results: Healthy Blacks have a greater psoas index than Whites (0.8995 vs. 0.6988, p=0.004). When comparing patients with PC, Blacks and Whites were found to have similar psoas indices. Black patients had a greater percent decrease in psoas index than White patients (-25.29% vs. -12.37%, p=0.04). Tumor size inversely correlated to psoas index in Blacks (r=0.4330, p=0.007), but not in Whites (r=0.0025, p=0.9). Similar to tumor size, the positive lymph node ratio (LNR) inversely correlated to psoas index in Black patients (r=0.3930, p=0.01), but not in White patients (r=0.0867, p=0.2). LNR was significantly greater in Whites than Blacks (0.0627 vs. 0.2253, p=0.002), but overall survival was similar in both groups (15.8 vs. 14.3, p=0.7). In whole-exome sequencing, there were 22 mutations, of which several harbored implications in chemoresistance (ABCF1, ANAPC1), metastasis (CYP2A7, CYP21A2), and pathways of tumorigenesis (PHACTR4, PPP1R12B), and had 100% penetrance in Blacks but not in Whites. Seven mutations were present only in tumors of Whites but not Blacks. Conclusion: Black Americans with PC suffer more muscle loss in the early stages of disease than Whites. A decreased psoas index in Black patients is associated with worse prognostic factors. In our genetic analysis, we identified 27 novel mutations not before reported in the literature. We conclude that recognizing biological variance in patients may underlie health disparities and allow investigations toward defining specific targets in a diverse group of patients with PC. Citation Format: Miles E. Cameron, Patrick W. Underwood, Jinping Lai, Jennifer B. Permuth, Andrew R. Judge, Jose G. Trevino. Unique patient signatures underlie health disparities in ethnically diverse patients with pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4004.

Sarcopenia as a Possible Negative Predictor of Limb Salvage in Patients with Chronic Limb-Threatening Ischemia.

Objective: Open revascularization of the lower extremity in patients with chronic limb-threatening ischemia (CLTI) does not guarantee limb salvage. Due to the high prevalence of frailty among these patients, we hypothesized that sarcopenia negatively affects limb prognosis.Methods: Seventy-five CLTI patients who underwent open revascularization between 2011 and 2015 were retrospectively reviewed. The lumbar psoas index, which is the ratio of the cross-sectional area of the psoas major muscles to the patients’ height squared, was used as a surrogate marker for sarcopenia. Male and female patients were stratified separately according to lumbar psoas index values. The lower two-thirds of the population for each sex were defined as the sarcopenia group, with the higher third defined as the non-sarcopenia group.Results: Comorbidities and ambulatory status did not differ between the sarcopenia (n=50) and non-sarcopenia (n=25) groups. The sarcopenia group had significantly lower overall survival rates than the non-sarcopenia group (60% vs 87% at 3 years, P<0.05). Moreover, the limb salvage rates were significantly lower in the sarcopenia group than in the non-sarcopenia group (73% vs 100% at 2 years, P<0.05).Conclusion: Sarcopenia, as measured by the lumbar psoas index, may predict poor limb prognosis in CLTI patients undergoing open revascularization.

Easy surveillance of muscle volume decline in chronic liver disease patients using finger-circle (yubi-wakka) test.

BackgroundMuscle atrophy (MA) and muscle strength decline are important clinical features in chronic liver disease (CLD) patients. An easy to perform MA screening method without need for special equipment would be helpful. We evaluated the usefulness of the previously reported finger‐circle test as screening for MA in CLD patients.MethodsWe retrospectively enrolled 358 Japanese CLD outpatients (70.8 ± 10.2 years, male/female = 234/124) who had undergone a computed tomography examination from December 2017 to March 2018, of whom 137 had chronic hepatitis, 169 had liver cirrhosis Child–Pugh A, and 52 had liver cirrhosis Child–Pugh B/C. Bilateral psoas muscle area at the middle of the third lumber vertebra (L3) was evaluated with computed tomography findings, which was performed as a screening of hepatocellular carcinoma, using a previously reported parameter for MA [psoas index (PI): total psoas muscle area (cm2)/height (m)2] [mean PI ± standard deviation (SD) of male patients: 6.50 ± 1.13 cm2/m2 and those of female patients: 4.30 ± 0.90 cm2/m2]. We then evaluated the correlation between MA and finger‐circle test results in these patients.ResultsThe mean PI values for finger‐circle test results Bigger, Just‐fits, and Smaller were 5.64 ± 1.34, 5.00 ± 1.25, and 4.83 ± 1.46 cm2/m2, respectively, in male patients (P < 0.001) and 4.31 ± 1.06, 3.93 ± 0.97, and 3.42 ± 0.94 cm2/m2, respectively, in female patients (P = 0.001). We found that a finger‐circle test result in male patients other than Bigger (Just‐fits and Smaller) predicted a decline in psoas muscle area of L3 to PI 5.25 cm2/m2 (sensitivity/specificity 0.619/0.667, area under the curve 0.654, 95% confidence interval 0.583–0.724), which was approximately mean minus 1 SD (5.37 cm2/m2). On the other hand, a Smaller test result in female patients predicted a decline in psoas muscle area of L3 to PI 3.33 cm2/m2 (sensitivity/specificity 0.740/0.583, area under the curve 0.698, 95% confidence interval 0.583–0.813), approximately mean minus 1 SD (3.40 cm2/m2).ConclusionsThe finger‐circle test is an easy to perform and effective screening method for predicting earlier stage of MA in CLD patients without the need for special equipment.

Саркопенія як фактор прогнозування розвитку післяопераційних ускладнень у хворих з аденокарциномою підшлункової залози

Мета. Визначення впливу саркопенії на виникнення ускладнень після резекційних оперативних втручань на підшлунковій залозі (ПЗ) з приводу її злоякісних пухлин.&#x0D; Матеріали і методи. Проведено ретроспективний аналіз результатів лікування 87 пацієнтів, яким були виконані радикальні оперативні втручання. За допомогою передопераційної комп’ютерної томографії (КТ) розраховували в одиницях Хаунсфільда (од. Х.) середнє значення щільності (Hounsfield Unit Average Calculation - HUAC) та сумарний індекс (Total Psoas Index - TPI) великого поперекового м’яза на рівні ІІІ поперекового хребця.&#x0D; Результати. У 35 (40,2%) пацієнтів виявили саркопенію, застосовуючи показник HUAC. Післяопераційні ускладнення виникли у 21 (60%) хворого з саркопенією, померли 2 (5,7%) хворих. Післяопераційні ускладнення виникли у 16 (30,8%) хворих без саркопенії, помер 1 (1,9%) хворий. Застосовуючи показник TPI, саркопенію діагностували у 38 (43,7%) хворих, із них ускладнення виникли у 21 (55,3%), померли 2 (5,3%). Ускладнення виникли у 16 (32,6%) хворих без саркопенії, помер 1 (2,0%) хворий.&#x0D; Висновки. Саркопенія достовірно впливає на частоту післяопераційних ускладнень, її виявлення може бути використано для покращення відбору пацієнтів перед виконанням резекції ПЗ з приводу її злоякісних новоутворень.

Can Sarcopenia Quantified by Computed Tomography Scan Predict Adverse Outcomes in Emergency General Surgery?

BackgroundSarcopenia (a decline of skeletal muscle mass) has been identified as a predictor of poor postoperative outcomes. The impact of sarcopenia in emergency general surgery (EGS) remains undetermined. The aim of this study was to evaluate the association between sarcopenia and outcomes after EGS. MethodsA 3-y (2012-15) review of all EGS patients aged ≥45 y was presented to our institution. Patients who underwent computer tomography–abdomen were included. Sarcopenia was defined as the lowest sex-specific quartile of total psoas index (computer tomography–measured psoas area normalized for body surface area). Patients were divided into sarcopenic (SA) and nonsarcopenic. Primary outcome measures were in-hospital complications, hospital-length of stay [h-LOS], intensive care unit-length of stay, adverse discharge disposition, and in-hospital mortality. Our secondary outcome measures were 30-d complications, readmissions, and mortality. ResultsFour hundred fifty-two patients undergoing EGS were included. Mean age was 58 ± 8.7 y, and 60% were males. Hundred thirteen patients were categorized as SA. Compared to nonsarcopenic, SA patients had higher rates of minor complications (28% versus 17%, P = 0.01), longer hospital-length of stay (7d versus 5d, P = 0.02), and were more likely to be discharged to skilled nursing facility/Rehab (35% versus 17%, P = 0.01). There was no difference between the two groups regarding major complications, intensive care unit-length of stay, mortality, and 30-d outcomes. On regression analysis, sarcopenia was an independent predictor of minor complications (OR 1.8 [1.6-3.7]) and discharge to rehab/SNIF (OR: 1.9 [1.5-3.2]). However, there was no association with major complications, mortality, 30-d complications, readmissions, and mortality. ConclusionsSarcopenia is an independent predictor of minor postoperative complications, prolonged hospital-length of stay, and an adverse discharge disposition in patients undergoing EGS. Identifying SA EGS patients will improve both resource allocation and discussion about the patient's prognosis between physicians, patients, and their families.

P3.01-36 Prognostic Factors in Elderly Patients with Advanced Non-Small Cell Lung Cancer

There is no consensus method for identifying frail older patients. A number of clinical screening tests are now available but the prediction of outcome of treatment is difficult. Sarcopenia, as simply determined by a baseline Computed Tomography (CT) image, has been shown to be predictive of prognosis in Lung Cancer (LC). The purpose of this analysis was to determine the prognostic significance of CT determined sarcopenia, and other clinical parameters, on overall survival (OS) among elderly patients with advanced-stage Non-Small Cell Lung Cancer (NSCLC) and on active treatment. We also sought to determine the OS of this population, according to the different clinical parameters evaluated. A retrospective analysis of 77 patients older than 65 years old with advanced NSCLC and ECOG PS 0-2 treated between 2014 and 2017 was performed. The variables tested were age, gender, ECOG PS, polypharmacy (the use of 5 or more medications), The Charlson Comorbidity Index (CCI), Body Mass Index (BMI), Lactate dehydrogenase value and sarcopenia. For the quantification of Sarcopenia two methods were used: Total Psoas Index (TPI) and the Hounsfield Unit Calculation (HUAC). Both obtained from a single axial Computed Tomography (CT) image at L3 level. Median OS was assessed by Kaplan-Meier method. Cox survival analysis was performed for a 95% CI for the hazard ratios, considering a p value of 0.05 as an indicator of statistical significance. Analyses were performed with use of SPSS v.18 software. On our population we found sex, CCI and polypharmacy as independent risk factors associated with mortality. Median OS of the population was 14 months. Men and patients who presented with ECOG PS 2, BMI below 22 Kg/m2 and sarcopenia had worse outcome, but without statistical significance. Clinical variables may help to discuss prognosis with elderly LC patients. The identification of these factors can be used to improve patient selection for the different treatment options.

MP61-11 TEMPORARY CONTRAINDICATION OF OBESE RECIPIENTS IN KIDNEY TRANSPLANTATION: A NEW MORPHOMETRIC TOOL FOR DECISION SUPPORT.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018MP61-11 TEMPORARY CONTRAINDICATION OF OBESE RECIPIENTS IN KIDNEY TRANSPLANTATION: A NEW MORPHOMETRIC TOOL FOR DECISION SUPPORT. Ugo Pinar, Yohann Renard, Dina Bedretdinova, Cedric Lebacle, Bastien Parier, Yacine Hammoudi, Jacques Irani, and Thomas Bessede Ugo PinarUgo Pinar More articles by this author , Yohann RenardYohann Renard More articles by this author , Dina BedretdinovaDina Bedretdinova More articles by this author , Cedric LebacleCedric Lebacle More articles by this author , Bastien ParierBastien Parier More articles by this author , Yacine HammoudiYacine Hammoudi More articles by this author , Jacques IraniJacques Irani More articles by this author , and Thomas BessedeThomas Bessede More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1990AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Based on body mass index (BMI) and/or clinical examination, morbid obesity can be a temporary contraindication (TCI) of kidney transplantation. However, BMI alone does not evaluate the intra- or extra-peritoneal distribution of fatty tissue, and clinical examination alone is subjective. The objective was to evaluate the interest of morphometric criteria to ensure a reproducible and consensual decision of TCI. METHODS A retrospective monocentric study from 2012 to 2017 included all patients with a BMI greater than 30 who had been transplanted or temporarily contraindicated because of their overweight. Based on a semi-automatic Hounsfiled density detection software, the following measurements were performed on CT-scans sections at L3 and L4 levels: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipous Tissue surface (VAT), Vessels-to-Skin Distance (VSK), L4 abdominal perimeter (AP), psoas index, Skeletal Muscle Index (SMI). A univariate ROC-analysis was performed for each measure and for BMI. A multivariate logistic model of all of the measurements was performed. Relevant variables were determined by the backward elimination procedure. The multivariate logistic model′s ROC-curve was compared to the BMI′s ROC-curve. RESULTS Ninety-seven potential recipients with a BMI greater than 30 were identified; 76 of them received a kidney-transplant. Their mean (+/-SD) characteristics were: BMI=33(+/-3.5)kg/m2; AP=894(+/-164)mm; VAT=235(+/-104)cm2; and VSK=14.2(+/-2.3)cm. Mean (+/-SD) characteristics of the 21 contraindicated recipients were: BMI=36.7(+/-3.8)kg/m2; AP=1123(+/-173)mm; VAT=347(+/-141)cm2; and VSK=17.4(+/-2.6)cm. The area under the curve (AUC, 95%CI) for the BMI-model was 0.81 (0.72-0.90) (Fig.1A); the AUC of the 5-variable model was 0.88 (0.78-0.98) (Fig.1B). CONCLUSIONS Obesity morphometric parameters are associated with TCI decision in kidney transplantation. Combined with BMI in a ″morphometric tool″, they were predictive of a TCI decision. Utilizing a morphometric threshold or nomogram could provide a more accurate and objective criteria than BMI and/or clinical examination alone in order to decide TCI for kidney transplantation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e827 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ugo Pinar More articles by this author Yohann Renard More articles by this author Dina Bedretdinova More articles by this author Cedric Lebacle More articles by this author Bastien Parier More articles by this author Yacine Hammoudi More articles by this author Jacques Irani More articles by this author Thomas Bessede More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Psoas Muscle Size Predicts Risk-Adjusted Outcomes After Surgical Aortic Valve Replacement

Frailty is an important predictor of outcomes after cardiac surgery, but utility is limited by difficult assessment and quantification. We hypothesize that sarcopenia defined as psoas muscle cross-sectional area is a useful predictor of surgical aortic valve replacement outcomes in moderate to high-risk patients. Moderate to high risk patients (predicted risk of mortality greater than 3%) who underwent surgical aortic valve replacement with or without coronary artery bypass were extracted from an institutional database (2009 to 2016). Psoas index was calculated as the cross-sectional area of the psoas muscle at the L4 vertebral level normalized to body surface area. Patients were stratified by sarcopenia status, defined as less than 25th sex-specific percentile. Multivariable regression analysis identified risk-adjusted associations with psoas index using The Society of Thoracic Surgeons predicted risk scores. Of the 240 patients included, the median predicted risk of mortality was 6%, median age 80 years, and 40% were female. Patients with (33.3%) and without (66.7%) sarcopenia had equivalent baseline risk (median predicted risk of mortality 5.7% versus 6.0%, p= 0.29). Patients with sarcopenia had higher 1-year mortality (31.9% versus 16.9% p= 0.03). Psoas index significantly predicted risk-adjusted 1-year mortality (odds ratio 0.84, p= 0.02) and long-term mortality (hazard ratio 0.92, p= 0.04), as well as risk-adjusted major morbidity, prolonged ventilation, length of stay, discharge to a facility, and hospital cost. Finally, psoas index measurements were highly reproducible (Pearson correlation coefficient 0.944). Psoas index is an easily obtained and reproducible measure of frailty that predicts risk-adjusted resource utilization, morbidity, and long-term mortality. Psoas index may improve procedural selection and risk adjustment in high-risk patients with aortic valve disease.

Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p < 0.05). Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is a simple and objective measure of frailty that identifies vulnerable patients for improved preoperative counseling, setting realistic goals of care, and consideration of less invasive approaches. Prognostic study, level III.

Psoas muscle volume as a predictor of peripheral neurotoxicity induced by primary chemotherapy in ovarian cancers.

Low skeletal muscle mass (sarcopenia) has been reported to have an influence on survival and toxicities of chemotherapy in several solid tumors. The impact of sarcopenia on the treatment of ovarian cancers has not been determined. The present study aimed to evaluate correlation between sarcopenia and toxicities of chemotherapy in ovarian cancers. Medical charts of the ovarian cancer patients that received chemotherapy with paclitaxel and carboplatin at our hospital between 2010 and 2015 were retrospectively reviewed. Muscle areas of bilateral psoas major muscles at the fifth lumbar vertebra were measured using images obtained by computed tomography. The volume of muscle and clinicopathological factors were evaluated for toxicities of chemotherapy. The protocol of the present study was approved by the institutional review board of our institution. A total of 76 patients with ovarian cancers were identified, and enrolled in the present study. Median psoas index (PI, the psoas muscle major cross-sectional area divided by the height squared) was 583mm2/m2 (range 326-999). The patients with low PI developed peripheral neuropathy more frequently compared with those with high PI (32 vs. 11%; P=0.047). PI value was not associated with other toxicities such as neutropenia and thrombocytopenia. PI value was associated with grade 2 or higher peripheral neuropathy in univariate analysis (OR=3.92; 95% CI 1.21-15.32; P=0.02) and multivariate analysis (OR=3.93; 95% CI 1.17-15.87; P=0.03). PI value was significantly associated with peripheral neuropathy induced by combination therapy with paclitaxel and carboplatin in ovarian cancer patients. Although further studies are needed to confirm the results, the volume of skeletal muscle mass could be a potential biomarker to predict toxicities in ovarian cancer patients.

Computed tomography measured psoas density predicts outcomes in trauma

Age-related loss of muscle mass and function (sarcopenia) is linked to poor outcomes after operation and trauma. Here we evaluate computed tomography measured psoas muscle density and area using quick and simple tools available to the bedside clinician. We hypothesize these measures will predict poor outcomes after blunt traumatic injury. We conducted a retrospective cohort study of patients ages ≥45years in the Ohio State University Trauma Registry in 2008 that received a computed tomographic scan of the abdomen and/or pelvis with intravenous contrast. Psoas Index and Hounsfield unit average calculation were measured at the L3 level. In the study, 90-day mortality, complication, duration of stay ≥7days, and dependent discharge were compared with Psoas Index and Hounsfield unit average calculation. In the study, 151 patients met the inclusion criteria. Patients were stratified into interquartile ranges based either on Psoas Index or Hounsfield unit average calculation values. After adjustment with sex-specific cutoffs, the lowest interquartile range of Psoas Index was associated with 90-day mortality (relative risk [RR] 5.95, P<.008), but did not reach significance in other outcomes. The lowest interquartile range of Hounsfield unit average calculation was associated with 90-day mortality (RR5.95, P<.008), duration of stay≥7days (RR 1.63, P=.048), complication risk (RR 2.30, P=.002), and dependent discharge 2.14, P=.015). Psoas muscle density is a significant predictor of poor outcomes after traumatic injury. This objective, quick, and readily available measure of sarcopenia can identify patients requiring aggressive nutritional and physical therapy to improve prognosis, prevent recurrent traumatic injury, and aid in discharge planning.

Robotic pancreaticoduodenecectomy improves outcomes for patients with high risk morphometric features

Objective: Body morphometry has been shown to predict adverse outcomes in patients undergoing open pancreaticoduodenectomy (OPD). We hypothesized that robotic pancreaticoduodenectomy (RPD) may mitigate adverse outcomes in sarcopenic patients compared to OPD. Methods: An institutional database was queried for all patients undergoing RPD or OPD from 2011 to -2015. Morphometric parameters including total psoas index (TPI=total psoas area normalized for height)), visceral-subcutaneous fat ratio (VSR) and average psoas attenuation (APA) were derived from segmentation of CT imaging at L3. Quantile regression was used to evaluate the effect of morphometric parameters on morbidity, pancreatic fistula, LOS, readmission, and disharge disposition. Results: Of 426 PDs, 221 patients had imaging acceptable for morphometric analysis. RPD (n=100) and OPD (n=121) groups were comparable in age, sex, CCI, and pre-operative serum albumin (all P>0.05). Mean morphometric parameters (TPI, VSR, and APA) were similar between OPD and RPDs (all p>0.05). VSR was associated with serious complications (Clavien III+) in the OPD cohort (OR 2.06, p=0.05) but not the RPD cohort (OR 1.30, p=0.29). Using quantile regression, low APA (defined as bottom 25%) was not associated with risk of increased LOS at the 25th, 50th, or 75th percentiles (p=1.00) in RPD patients, whereas In the OPD group, low APA was associated with 2, 1 and 3 additional hospital days at the 25th, 50th and 75th percentile LOS respectively(P=0.046). Conclusion: RPD may be associated with shorter LOS and improved outcomes in patients with high risk morphometric features.

A clinically applicable muscular index predicts long-term survival in resectable pancreatic cancer

The relationship between myopenia, nutritional status, and long-term oncologic outcomes remains poorly characterized in patients with clinically resectable pancreatic cancer. We sought to reliably quantify prognostic indicators of preoperative cachexia in a manner applicable to any clinical setting. Preoperative computed tomographies were available electronically and suitable for analysis in 73 of 82 consecutive patients with pancreatic cancer undergoing pancreatoduodenectomy between November 2010 and February 2014. The psoas index was computed from the cross-sectional area of the psoas muscles normalized to vertebral body area at the third lumbar vertebra. Correlation and proportional hazards analyses were performed to identify relationships between muscularity, preoperative nutritional markers, clinicopathologic parameters, and long-term survival. The psoas index correlated strongly with preoperative hemoglobin and albumin levels (P=.001 and .014, respectively) identifying a pattern of preoperative frailty. High psoas index and the albumin and hemoglobin levels were associated with improved long-term survival (hazard ratio 0.014, P<.001; hazard ratio 0.43, P<.001; and hazard ratio=0.80, P=.014); however, on multivariate analysis, the psoas index proved to be the only independent predictor of survival (hazard ratio 0.021; P=.003). Rapid decreases in the psoas index during neoadjuvant chemotherapy were associated with poor postoperative outcomes, as were decreases in the psoas index during the postoperative period. The data indicate that the psoas index, a calculation derived from a clinically mandated, preoperative computed tomography, is a statistically powerful and easily calculated predictor of survival in pancreatic cancer when compared to tumor grade and stage as well as previously validated nutritional parameters.

Sarcopenia and two types of presarcopenia in Japanese patients with chronic liver disease.

The frequency of sarcopenia, defined as loss of both muscle volume and strength, was analyzed in chronic liver disease (CLD). From April to September 2015, 807 Japanese CLD patients treated as outpatients were enrolled (67.1±10.0 years, men : women=466 : 341, hepatitis C virus : hepatitis B virus : hepatitis B and C virus : alcohol : other=511 : 134 : 3 : 45 : 114). Sarcopenia was diagnosed when the patient showed muscle volume loss and reduced handgrip strength, whereas those with only muscle volume loss were classified as 'v-presarcopenia' and those with only reduced handgrip strength were classified as 's-presarcopenia'. Muscle volume loss was determined using computed tomography findings and a previously reported index (psoas index), and cut-off values for reduced handgrip strength presented by the Asia Working Group for Sarcopenia (AWGS) (AWGS/grip criteria) and European Working Group on Sarcopenia in Older People (EWGSOP) (EWGSOP/grip criteria) (men; 26 and 30 kg, women; 18 and 20 kg, respectively) were used. Clinical features were analyzed for diagnoses of chronic hepatitis (CH, n=381), liver cirrhosis Child-Pugh A (n=330), and liver cirrhosis Child-Pugh B/C (n=96). When the AWGS/grip criteria were used, the frequencies of sarcopenia, v-presarcopenia, and s-presarcopenia in CH were 3.9, 7.9, and 19.4%, whereas those in Child-Pugh A were 4.8, 17.6, and 21.8% and those in Child-Pugh B/C were 16.7, 11.5, and 39.6%, respectively. When the EWGSOP/grip criteria were used, these frequencies were 7.1, 4.7, and 33.1%, in CH, 11.8, 10.6, and 32.7%, in Child-Pugh A, and 21.9, 6.3, and 49.0%, in Child-Pugh B/C, respectively. The incidence rates of sarcopenia and both types of presarcopenia increased with progression of CLD. Evaluation of handgrip strength and psoas index is an easy and effective method for the detection of sarcopenia and presarcopenia.