Sarcopenia Index Research Articles

(265) - The Serum Sarcopenia Index is Associated with Post LVAD Mortality

(265) - The Serum Sarcopenia Index is Associated with Post LVAD Mortality

Abstract P103: Alterations in Sarcopenia Index Are Associated With Inflammation, Gut and Oral Microbiota Among Heart Failure, Left Ventricular Assist Device and Heart Transplant Patients

Introduction: Sarcopenia, characterized by loss of muscle mass and function, is prevalent in heart failure (HF) and associated with poor outcomes. We investigated alterations in sarcopenia index (SI), a surrogate marker of skeletal muscle mass, in HF, left ventricular assist device (LVAD) and heart transplant (HT) and assessed its relationship with inflammation and digestive tract (gut and oral) microbiota. Hypothesis: Sarcopenia will be associated with increased inflammation, dysbiotic microbial signatures, higher HF class, and earlier time post-HT or post LVAD. Methods: We enrolled 460 HF, LVAD and HT patients. Repeated measures pre and post procedures were obtained in a subset of LVAD and HT patients. Sarcopenia index (serum Creatinine/Cystatin C) and inflammatory biomarkers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha) were measured in 271 and 622 blood samples, respectively. Gut and saliva microbiota were assessed via 16S rRNA sequencing among 335 stool and 341 saliva samples. Multivariable regression models were used to assess the relationship between SI and i) New York Heart Association class; ii) pre- vs. post-LVAD or HT; iii) biomarkers of inflammation and microbial diversity. Results: Median (interquartile range) ln-SI was -0.13(-0.32,0.05). Ln-SI decreased across worsening HF class, further declined within the 1-month after LVAD and HT and rebounded over time to the levels of symptomatic HF. Ln-SI demonstrated an inverse correlation with inflammation (r=-0.28, p<0.0001), and a positive correlation with gut (r=0.26, p<0.0001) and oral microbial diversity (r=0.24, p<0.0001). Presence of the gut taxa Roseburia inulinivorans was associated with increased SI. Conclusions: SI levels decreased in symptomatic HF and remained decreased long-term after LVAD and HT. SI levels covaried with inflammation, gut and oral microbiota in a similar fashion.

O100: A novel bedside assessment of skeletal muscle wasting predicts treatment-related toxicity prior to major surgery – The Muscle Ultrasound in Esophagogastric Cancer (MUSEC) study

Abstract Sarcopenia is an important prognosticator during treatment for Oesophagogastric (OG) cancer. Despite this, sarcopenia is not routinely measured in clinical practice due to resource availability. Ultrasound is emerging as a potential tool to quantify muscle mass and quality and might predict treatment-related complications. Skeletal muscle ultrasound has not been investigated in patients undergoing cancer treatment. Patients receiving treatment for OG cancer (chemotherapy plus surgery) were prospectively recruited. Ultrasound was performed at 4 time points during treatment. Primary outcome was a measurable change in skeletal muscle. Secondary outcome measures included correlation with gold-standard measures of muscle mass (CT skeletal muscle index (SMI)), and the association between sarcopenia on ultrasound and treatment-related complications. Fifty patients were recruited. Significant deterioration in quadriceps muscle thickness, cross sectional area, rectus femoris echointensity, and ultrasound sarcopenia index (USI) was observed during chemotherapy. USI showed moderate correlation with CT SMI (r = -.511, p=0.001) with ultrasound classifying more patients as sarcopenic (37% vs 18%, p=0.001), plus detecting a greater magnitude of muscle loss during chemotherapy (-20.2 ±18% vs -6.5 ±7.4%, p=<0.001). USI correlated better with physical function (1-minute sit to stand) compared to CT SMI (r .589, p=<0.001 versus r .149, p=0.169). Ultrasound-defined sarcopenia at baseline was associated with a higher incidence of dose limiting chemotoxicity and severe chemotoxicity but did not post-operative complications. Further validation studies are required, but bedside muscle ultrasound could provide an effective bedside assessment of muscle health and identifies a higher proportion of patients at risk of chemotoxicity prior to major surgery.

Diabetes Mellitus Should Be Considered While Analysing Sarcopenia-Related Biomarkers.

Sarcopenia is a chronic, progressive skeletal muscle disease characterised by low muscle strength and quantity or quality, leading to low physical performance. Patients with type 2 diabetes mellitus (T2DM) are more at risk of sarcopenia than euglycemic individuals. Because of several shared pathways between the two diseases, sarcopenia is also a risk factor for developing T2DM in older patients. Various biomarkers are under investigation as potentially valuable for sarcopenia diagnosis and treatment monitoring. Biomarkers related to sarcopenia can be divided into markers evaluating musculoskeletal status (biomarkers specific to muscle mass, markers of the neuromuscular junction, or myokines) and markers assuming causal factors (adipokines, hormones, and inflammatory markers). This paper reviews the current knowledge about how diabetes and T2DM complications affect potential sarcopenia biomarker concentrations. This review includes markers recently proposed by the expert group of the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) as those that may currently be useful in phase II and III clinical trials of sarcopenia: myostatin (MSTN); follistatin (FST); irisin; brain-derived neurotrophic factor (BDNF); procollagen type III N-terminal peptide (PIIINP; P3NP); sarcopenia index (serum creatinine to serum cystatin C ratio); adiponectin; leptin; insulin-like growth factor-1 (IGF-1); dehydroepiandrosterone sulphate (DHEAS); C-reactive protein (CRP); interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). A better understanding of factors influencing these biomarkers' levels, including diabetes and diabetic complications, may lead to designing future studies and implementing results in clinical practice.

Association between macro- and microvascular damage and sarcopenia index in individuals with type 2 diabetes mellitus.

Sarcopenia was recently reported to be relevant to an increased macro-and microvascular disease risk. Sarcopenia index (SI) has been identified as a surrogate marker for sarcopenia. The aim of the present study was to investigate the association between macro- and microvascular disease and SI in patients with type 2 diabetes mellitus (T2DM). A total of 783 patients with T2DM were enrolled in this cross-sectional study. The SI was calculated by (serum creatinine [mg/dL]/cystatin C [mg/L])×100. The subjects were divided into three groups according to SI tertiles: T1 (41.27-81.37), T2 (81.38- 99.55), and T3 (99.56-192.31). Parameters of macro- and microvascular complications, including diabetic retinopathy (DR), micro- and macroalbuminuria (MAU), diabetic peripheral neuropathy (DPN), and lower extremity peripheral artery disease (LEAD) were evaluated. Multivariate logistic regression analysis revealed that when taking the top tertile of SI as a reference, an increasing trend of the prevalence of DR, MAU, DPN, and LEAD were presented (all P for trend <0.05), where the OR (95% CI) for DR prevalence was 1.967 (1.252-3.090) in T2, 2.195 (1.278-3.769) in T1, for MAU was 1.805 (1.149-2.837) in T2, 2.537 (1.490-4.320) in T1, for DPN was 2.244 (1.485-3.391) in T2, 3.172 (1.884-5.341) in T1, and for LEAD was 2.017 (1.002-4.057) in T2, 2.405 (1.107-5.225) in T1 (all P<0.05). Patients with lower SI were more inclined to have an increased risk of macro- and microvascular damage in T2DM population, which may be related to sarcopenia.

Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery

BackgroundPatients undergoing cardiac surgery are exposed to many factors that activate catabolic and inflammatory pathways, which affect skeletal muscle and are, therefore, related to unfavorable hospital outcomes. Given the limited information on the behavior of muscle mass in critically ill patients, the objective of this study was to evaluate the impact on quantitative and qualitative measurements of quadriceps muscle mass using ultrasound after cardiac surgery. To accomplish this, a prospective, descriptive, and correlational study was conducted at a tertiary care hospital. Quadriceps muscle mass was evaluated via ultrasound in 31 adult patients in the postoperative period of cardiac surgery, with daily follow-up until postoperative day 7, as well as an assessment of associations with negative outcomes at 28 days.ResultsA 16% reduction in the cross-sectional area of the rectus femoris was found (95% CI 4.2–3.5 cm2; p 0.002), as well as a 24% reduction in the pennation angle of the rectus femoris (95% CI 11.1–8.4 degrees; p: 0.025). However, changes in the thickness of the rectus femoris, vastus internus, vastus lateralis, the length of the fascicle of the vastus lateralis, the pennation angle of the vastus lateralis, the sarcopenia index, and the Hekmat score were not statistically significant. There was no significant association between quadriceps muscle mass measurements and Intensive Care Unit (ICU) length stay or 28-day mortality.ConclusionsPatients in the postoperative period of cardiac surgery evaluated by ultrasound exhibit both quantitative and qualitative changes in quadriceps muscle mass. A significant reduction in muscle mass is observed but this is not associated with unfavorable outcomes.

Value of Cystatin C-Based Sarcopenia Index in Patients Undergoing Surgery for Renal Tumors

IntroductionSarcopenia is a condition of low muscle strength and quantity, severe if low physical performances. The sarcopenia index (SI), calculated by blood levels of creatinine and cystatin C, had been reported to be correlated with skeletal muscle mass and is a potential simple screening tool for sarcopenia. We hypothesized that patients with a low SI, meaning low muscle mass, would have an inflated estimated glomerular filtration rate (eGFR) value based on serum creatinine levels. We also tested the prognostic value of the SI in a cohort of patients who had surgery for renal malignancies. Patients and MethodsWe conducted a retrospective, observational study of 322 patients that had surgery for renal tumors in National Cancer Center Hospital East (Kashiwa, Chiba) between April 2017 and June 2023. We assessed sarcopenia measuring psoas muscle index (PMI), psoas muscle density (PMD), and skeletal muscle area (SMA) by computed tomography. We assessed the association between SI and eGFR before and after surgery. We also assessed the association between SI and postoperative outcome, including overall survival. ResultsOf the 322 patients, 211 (66%) were males, with a median age of 69 years. SI had a weak correlation with both PMI and PMD in males (PMI: ρ = 0.25; PMD: ρ = 0.21). In females, SI and PMD exhibited a low correlation (ρ = 0.26), while SI and PMI displayed an insignificant correlation (ρ = 0.19). The correlation between SMA and SI was moderate for both males and females (males: ρ = 0.51; females: ρ = 0.46). After radical nephrectomy, eGFR decreased in 98% of patients with high SI, compared to 69% of patients with low SI. We also demonstrated that low SI predicted poor prognosis. ConclusionsClinicians can recognize the possibility of overestimated eGFR in the low SI group by measuring SI around the surgery. Low SI may also help predict poor prognosis.

Diagnostic test accuracy of serum creatinine and cystatin C-based index for sarcopenia: a systematic review and meta-analysis.

Sarcopenia is an important prognostic factor, but its optimal screening methods remain challenging. Several new indices developed based on serum creatinine (Cr) and cystatin C (CysC) have been proposed to be diagnostic biomarkers for sarcopenia screening. This review aimed to evaluate the diagnostic accuracy of serum Cr- and CysC-based indices for sarcopenia diagnosis. We systematically searched MEDLINE, EMBASE, SCIE and SCOPUS from inception to 2 April 2023. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model was used to synthesise the pooled sensitivity, specificity and area under the curves of the summary receiver operating characteristic (SROC-AUC). We retrieved 936 publications and included 16 studies with 5,566 participants (mean age ranged: 51.0-78.4years, 50.2% men). The prevalence of sarcopenia ranged from 7.8 to 69.5%. All included studies presented a moderate to high risk of bias. The serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia (pooled sensitivity: 0.67, 95% CI 0.57-0.75; pooled specificity: 076, 95% CI 0.67-0.83; pooled SROC-AUC: 0.78, 95% CI 0.74-0.81). The Cr/CysC ratio is the most widely studied index, followed by the Cr × eGFRcys index. Overall, both indicators had satisfactory and comparable performance in screening sarcopenia. Serum Cr- and CysC-based indices showed moderate diagnostic accuracy for sarcopenia. The most studied indices-the Cr/CysC ratio and Cr × eGFRcys index-had comparable diagnostic accuracy for evaluating sarcopenia and may serve as surrogate markers for sarcopenia. However, further validation is required to verify these findings.

Serum Creatinine-Cystatin C Based Screening of Sarcopenia in Community Dwelling Older Adults: A Cross-Sectional Analysis.

To compare the discriminative capabilities for the manifestation of sarcopenia or physical frailty between serum creatinine- and cystatin C-derived indices among community-dwelling older adults. Cross-sectional study. Primary Care and Community. We utilized a subset of data from the Frail Elderly in the Sasayama-Tamba Area (FESTA) study, which was initiated in 2015 to gather comprehensive information on various health-related parameters among community-dwelling older individuals (age ≥65 years). Five serum creatinine-cystatin C based indices including the Sarcopenia Index, the serum creatinine/cystatin C ratio, the disparity between serum cystatin-C-based and creatinine-based estimated GFR, the total body muscle mass index (TBMM), and the prediction equation for skeletal muscle mass index (pSMI) were employed. Sarcopenia and physical frailty were identified based on the Asian Working Group for Sarcopenia criteria and the revised Japanese version of the Cardiovascular Health Study criteria, respectively. The receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the discriminative abilities of these tools. In the analysis of 954 participants, 52 (5.5%) were identified with sarcopenia and 35 (3.7%) with physical frailty. Regarding sarcopenia discrimination, TBMM and pSMI both exhibited area under the curve (AUC) values exceeding 0.8 for both men and women. Concerning the identification of physical frailty, AUC values ranged from 0.61 to 0.77 for males and 0.50 to 0.69 for females. In the multivariate logistic regression analyses, only TBMM and pSMI consistently displayed associations with sarcopenia, irrespective of sex (P<0.001, respectively). On the other hand, no consistent associations were observed between the indices and physical frailty. This study provides a robust association of a serum creatinine- and cystatin C-derived indices, especially TBMM and pSMI, with sarcopenia among community-dwelling older adults. Conversely, the application of these indices for the screening of physical frailty has its constraints, necessitating further investigation.

Lower creatinine to cystatin C ratio is associated with an increased risk of MASLD: A cross-sectional and prospective study of 368,634 UK Biobank participants.

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects many populations, and screening out the high-risk populations at an early stage is a challenge. As a sarcopenia index, the relationship between creatinine to cystatin C ratio (CCR) and MASLD remains unclear. This cross-sectional, prospective study aimed to explore the relationship between CCR and MASLD. Design Firstly, explored the correlation between CCR and MASLD in cross-sectional analyses. Then excluded the population with baseeline diagnosis of MASLD and analyzed the association with baseline CCR levels and the onset of MASLD in the population with available follow-up data. Univariate and multivariate logistic regression analyses were used to calculate odds ratios (ORs) to evaluate the association between CCR levels and MASLD. This study included 368,634 participants from the UK Biobank for cross-sectional and prospective analyses. The demographic characteristics and laboratory measurements of all participants were obtained from the UK Biobank. MASLD was diagnosed according to the multi-society consensus nomenclature. Hepatic steatosis was defined as FLI ≥60. We grouped the study participants according to CCR tertiles. In cross-sectional analyses, participants in CCR tertile 1 had the highest MASLD risk (OR: 1.070, 95%CI: 1.053-1.088, p < .001). And the similar association was observed in the prospective analyses (CCR tertile 1 OR: 1.340, 95%CI: 1.077-1.660, p = .009; CCR tertile 2 OR: 1.217, 95%CI: 1.021-1.450, p = .029, respectively). After stratification by gender, the significant association between CCR and the onset of MASLD was only observed in males (CCR tertile 1 OR: 1.639, 95%CI: 1.160-2.317, p = .005; CCR tertile 2 OR: 1.322, 95%CI: 1.073-1.628, p = .005, respectively). Our results indicated that lower CCR was significantly associated with higher risk of MASLD, based on which predictive models can be developed to screen populations at high risk of developing MASLD.

LONGITUDINAL ASSOCIATION OF SERUM CREATININE- AND CYSTATIN-C–BASED INDICES WITH INCIDENT SARCOPENIA

Abstract Although a cross-sectional link between serum creatinine- and cystatin-C-based indices and sarcopenia has been established, the longitudinal association remains unclear. This study explored the longitudinal association between serum creatinine- and cystatin-C-based indices and the incidence of sarcopenia in community-dwelling older adults. Using a 2–4 year follow-up data from the Korean Frailty and Aging Cohort Study, 690 participants (mean age: 75.2±3.7 years; 45.9% men) without sarcopenia at baseline were analyzed. The association between the incidence of sarcopenia during a 4-year follow-up and serum creatinine-to-cystatin-C ratio, estimated glomerular filtration rate (eGFR) ratio (eGFRcystatin-C/eGFRcreatinine), sarcopenia index (serum creatinine×eGFRcystatin-C), predicted skeletal muscle mass index (pSMI), and total-body muscle mass index (TBMM) from baseline were compared. During the 4-year follow-up period, the incidence of sarcopenia was 21.5% in men and 14.7% in women. The pSMI and TBMM showed a higher area under the receiver operating characteristics curves (AUC) for predicting the incidence of sarcopenia in men (pSMI, AUC:0.616, p=0.003; TBMM, AUC:0.613, p=0.001) and women (pSMI, AUC:0.714, p=0.003; TBMM, AUC:0.714, p=0.001) than other indices. After adjusting potential confounders, higher pSMI and TBMM were associated with sarcopenia onset in men (pSMI, odds ratio [OR]: 0.417, 95% confidence interval [CI]: 0.237–0.733; TBMM, OR: 0.937, 95%CI: 0.901–0.975) and women (pSMI, OR: 0.166, 95%CI: 0.072–0.380; TBMM, OR: 0.906, 95%CI: 0.862–0.952). In conclusion, pSMI and TBMM demonstrated accurate predictive capabilities for sarcopenia. Higher pSMI and TBMM values were associated with sarcopenia incidence. These findings suggest pSMI and TBMM could be potential predictive biomarkers of sarcopenia in community-dwelling older adults.

Sarcopenia Index Predicts Short-Term Prognosis of Head and Neck Squamous Cell Carcinoma

The sarcopenia index (SI), calculated as [(serum creatinine/serum cystatin C) × 100], maybe a simpler alternative for measuring muscle mass than computed tomography (CT) and bioelectrical impedance analysis (BIA). We enrolled 112 patients with head and neck cancers (HNC). The correlation of the SI with muscle surface area measured by CT (CTMSA, n = 82) and muscle mass by BIA (BIA-MM, n = 41) was tested. Cutoff values were set for SI, CTMSA, and BIA-MM. Overall survival (OS) was compared between the high- and low-SI/CTMSA/BIA-MM groups. The SI was correlated with CTMSA (r = 0.43) and BIA-MM (r = 0.52). The optimal cutoff values of SI, CTMSA, and BIA-MM were 76.1 (area under the curve [AUC] = 0.67), 129.2 (AUC = 0.59), and 46.1 (AUC = 0.62), respectively. OS was significantly lower in the low-SI group (78% at 1 year and 69% at 2 years) than in the high-SI group (94% at 1 year and 86% at 2 years; p = 0.006). There was no significant difference in OS between the low-and high-CTMSA and -BIA-MM groups. The SI, which only requires a blood sample, is a useful marker of muscle mass that correlates with short-term prognosis in patients with HNC.

Relationship between the preoperative grip strength and postoperative shoulder strength of patients treated via reverse shoulder arthroplasty.

Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle disorder) is common in elderly people, but its effect on patients after RSA is not clear. We hypothesized that the preoperative sarcopenia indices of grip strength and general skeletal muscle mass would correlate with the clinical outcomes of RSA. Grip strength and general skeletal muscle mass were measured in patients scheduled (between 2016 and 2021) for primary RSA to treat cuff tear arthropathy, an unrepairable cuff tear, or osteoarthritis with a large cuff tear. Before surgery, grip strength was measured using a hydraulic dynamometer and general skeletal muscle mass was calculated from the appendicular relative skeletal muscle mass index (aRSMI) using dual-energy X-ray absorptiometry. In all, 58 patients were included; the minimal follow-up duration was 12months. The postoperative clinical results (pain, active range of motion, shoulder strength, and functional scores) were evaluated during scheduled outpatient visits. We calculated correlations between the preoperative sarcopenia indices, and the clinical results at the final follow-up. The mean preoperative grip strength and aRSMI were 21.6±4.0kg and 5.98±0.84kg/m2 in females and 30.6±7.5kg and 7.21±0.94kg/m2 in males, respectively; the grip strength and aRSMI were not associated with each other (P=.083). Ten females (25%) and 10 males (56%) met the criteria for sarcopenia. The postoperative abduction shoulder strength and Constant-Murley shoulder score increased significantly with higher preoperative grip strength (R=0.420 and P=.001; and R=0.497 and P<.001, respectively) and the American Shoulder and Elbow Surgeons score was related to the preoperative aRSMI (R=0.320, P=.039). The shoulder strength and functional score after RSA correlated positively with the preoperative grip strength. Measuring grip strength before RSA allows the surgeon to predict shoulder strength after RSA.

Association between the sarcopenia index and abnormal liver function in the adult population in the United States: a cross-sectional study

BackgroundThe objective of this study was to explore the association between the sarcopenia index and abnormal liver function in adult individuals in the United States.MethodologyThis study employed a rigorous cross-sectional analysis of data derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 2017 and 2018. The primary objective was to investigate the correlation between the sarcopenia index and abnormal liver function. To achieve this, an advanced multivariate regression model was utilized, allowing for comprehensive analysis and meticulous adjustment of relevant variables. To ensure the robustness of the findings, a visually appealing smooth curve was constructed, and a two-stage regression model was applied for validation. Additionally, a detailed gender-stratified analysis was conducted to further explore the association between the sarcopenia index and abnormal liver function within distinct subgroups.ResultsThrough our rigorous participant selection process, a total of 1756 individuals were included in the study. The meticulously adjusted multivariate regression model revealed a significant negative association between the sarcopenia index and abnormal liver function, with an adjusted odds ratio (OR) of 0.73 and a 95% confidence interval (CI) ranging from 0.63 to 0.86. The robustness of this association was further supported by the visually appealing smooth curve plot. Moreover, in the gender-stratified subgroup analysis, after meticulous adjustment for confounding factors, notable differences in this association emerged (males: OR = 0.8, 95% CI: 0.66–0.98; females: OR = 0.61, 95% CI: 0.47–0.79).ConclusionThis cross-sectional study yields robust evidence indicating a negative correlation between the sarcopenia index and abnormal liver function, predominantly observed among females.

Usefulness of a novel nutritional index associated with frailty and poor outcomes in patients with lower extremity arterial disease

Abstract Background Evidence has indicated the close association between malnutrition or frailty and adverse outcomes in patients with lower extremity arterial disease (LEAD) following endovascular treatment (EVT). We have previously proposed a novel and simply calculable nutritional index by using serum levels of triglyceride, total cholesterol and body weight (TCBI) which was a useful prognostic indicator for patients with several cardiovascular disorders such as coronary artery disease, cardiogenic shock and heart failure. However, the application of the TCBI in patients with LEAD has been rarely evaluated. Moreover, no study has simultaneously addressed the prognostic implication of nutritional and frailty indices. Purpose The aim of present study was to investigate the association between TCBI and an index of frailty and sarcopenia, computed tomography (CT)-based psoas muscle index (PMI), in patients with LEAD following EVT. Moreover, we assessed the prognostic implication of TCBI in this population. Methods This single-center retrospective analysis involved consecutive patients with LEAD who underwent EVT for the first time since 2009 to 2020 (n=591). We divided patients into three groups according to tertiles of TCBI: lowest tertile (T1, &amp;lt;731.1); middle tertile (T2, 731.1–1243.6); and highest tertile (T3, ≥1243.6). We measured cross-sectional areas of psoas muscle at the level of forth lumber vertebra by CT-scan and obtained PMI (psoas muscle area normalized by height) in study participants. Primary and secondary endpoints were all-cause death and major adverse cardiovascular and limb events (MACLE), the composite of cardiovascular death (CV death), non-fatal myocardial infarction, stroke, clinically driven target vessel revascularization (CD-TVR), major amputation and development to limb ischemia. Median and the range of follow up period was 2.3 and 0–10 years, respectively. Results There was a positive significant correlation between log-transformed TCBI and PMI (Spearman’s correlation coefficient (r) between TCBI and PMI: 0.31, p&amp;lt;0.0001) (Figure 1). Kaplan-Meier analyses revealed the lowest cumulative incidences of both all-cause death and MACLE in patients with the highest tertile of TCBI (Figure 2). Constantly, multivariate Cox hazard analyses adjusted by age, sex, prior myocardial infarction, diabetes, chronic kidney disease (≥ stage3), left ventricular ejection fraction, use of statins, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and serum albumin level indicated the decreased risk of all-cause death (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.44–0.91, p=0.02) and MACLE (HR: 0.73, 95% CI: 0.59–0.89, p=0.003) by increase of TCBI, respectively. Conclusion This study showed a potential pathological link between poor nutritional status and advanced frailty/sarcopenia, which was associated with increased risk of poor prognosis in patients with LEAD following EVT.

A baseline sarcopenia index based on creatinine/cystatin C for the prediction of stroke recurrence and mortality in older survivors of first ischemic strokes.

Older adults individuals have a higher risk of stroke recurrence, leading to high mortality and disability rates, which, in turn, hinders the achievement of healthy aging. This study aimed to assess the utility of a baseline sarcopenia index (SI) based on serum creatinine (Cr)/cystatin C (CysC) as a prognostic marker for the risk of stroke recurrence and mortality in first-ever ischemic stroke older survivors (ISOS). Data were obtained from an ischemic stroke cohort study. The baseline information was collected from medical records and face-to-face interviews with patients admitted between January 2010 and June 2016. Follow-up information was obtained from telephone interviews every 3 months to determine stroke recurrence and survival status. The SI was calculated from the Cr and CysC values in the medical records as Cr/CysC × 100. Using the first quantile of the SI as the cut-off value, the study participants were divided into the low muscle-mass group (low SI) and the high muscle-mass group (high SI). Cox regression analysis was used to assess the association between SI and recurrence and mortality. A total of 415 first-ever ISOS were enrolled, including 242 (58.31%) male and 173 (41.69%) female participants. In the high-SI group, the relapse and mortality rates were lower than those in the low-SI group (relapse: 20.58% vs. 30.77%; mortality:13.5% vs. 29.81%). After adjusting for confounding factors, the high-SI group was found to have a lower risk of relapse and mortality than the low-SI group (relapse: HR = 0.571; mortality: HR = 0.294). The SI was predictive of the long-term prognosis of IS recurrence and mortality in first-ever ISOS. After discharge, in addition to conventional medication, it is recommended that patients with low SI values actively receive treatment for sarcopenia to reduce the risk of stroke recurrence and mortality and promote healthy aging.

Comparison of the serum creatinine- and cystatin-C–based indices as screening biomarkers for sarcopenia in community-dwelling older adults

BackgroundSeveral creatinine- and cystatin-C–based indices have been proposed as sarcopenia predictors. This study aimed to compare serum creatinine- and cystatin-C–based indices as screening biomarkers for sarcopenia in community-dwelling older adults. MethodsA cross-sectional study was conducted on 945 participants aged between 70 and 84 years (men=47.5%; mean age=76.0 ± 3.9 years) from the Korean Frailty and Aging Cohort Study. The serum creatinine-to-cystatin-C ratio estimated glomerular filtration rate (eGFR) ratio (eGFRcystatin-C/eGFRcreatinine), sarcopenia index (serum creatinine × eGFRcreatinine), predicted skeletal muscle mass index (pSMI), and total body muscle mass index (TBMM) were compared. ResultsThe prevalence of sarcopenia was 19.9% in men and 14.0% in women. The pSMI and TBMM showed higher correlations with appendicular lean mass and grip strength in men (pSMI: rs=0.356–0.701, p < 0.001; TBMM: rs=0.320–0.730, p < 0.001) and women (pSMI: rs=0.299–0.669, p < 0.001; TBMM: rs=0.256–0.658, p < 0.001) than the other indices. The area under the receiver operating characteristic curves (AUC) of the serum indices for predicting sarcopenia showed the highest accuracy for pSMI (men: AUC=0.77, p < 0.001; women: AUC=0.71, p < 0.001). After adjusting for potential confounders, pSMI was associated with the likelihood of sarcopenia in both men (odds ratio [OR]=0.170; 95% confidence interval [CI]=0.103–0.279) and women (OR=0.167; 95% CI=0.087–0.321). ConclusionpSMI and TBMM accurately determined sarcopenia than the other indices. Furthermore, a higher pSMI was strongly associated with a decreased risk of sarcopenia compared to TBMM. These findings suggest pSMI as a potential biomarker for sarcopenia screening in community-dwelling older adults.

The Role of Sarcopenia in Overactive Bladder in Adults in the United States: Retrospective Analysis of NHANES 2011-2018.

To investigate the association between sarcopenia and overactive bladder (OAB) in a United States adult population from 2011 to 2018, and whether sarcopenia can predict the risk of OAB. We analyzed data from the 2011-2018 National Health and Nutrition Examination Survey in a cross-sectional study(NHANES) of 8746 participants, of whom 1213 were diagnosed with OAB, we analyzed correlations by sex, age, race, education level, marital status, household income-to-poverty ratio, hypertension, diabetes, strenuous work activity, moderate work activity, strenuous recreational activity, moderate recreational activity, blood urea nitrogen, creatinine, and uric acid levels using restricted cubic spline plots of dose-response curves, univariate and multivariate Logistic regression. Models based on sex, age, education, household income to poverty ratio, hypertension, diabetes, sarcopenia index, and cotinine were developed and evaluated using Nomogram, calibration curves, receiver operating characteristic curves, and clinical decision curves. Of the 1213 OAB patients, 388 (32.0%) were male and 825 (68.0%) were female. Univariate and multivariate Logistic regression analysis showed that sarcopenia index was negatively correlated with the prevalence of OAB (OR=0.084, 95% CI, 0.056 - 0.130, P <0.001;OR=0.456, 95%CI, 0.215-0.968, P= 0.0041). Dose curve analysis of the sarcopenia index and prevalence of OAB showed that the prevalence of OAB decreased significantly with increasing sarcopenia index. Sarcopenia was positively correlated with OAB (OR=2.400, 95%CI, 2.000 - 2.800, P <0.001;OR=1.46, 95%CI, 1.096 -1.953, P = 0.010). In addition, our model shows that sarcopenia can predict the prevalence of OAB (AUC = 0.750) and has some clinical decision-making implications. Sarcopenia is positively associated with the risk of OAB in United States adults and can be used as a predictor of OAB prevalence.

Sarcopenia assessments as predictors of overall survival in patients with metastatic renal cell carcinoma.

Sarcopenia represents an important prognostic marker in tumor patients. However, measurement methods and threshold values are not uniformly defined. The aim of this study is therefore to determine the prognostic value of current definitions of sarcopenia in patients with metastatic renal cell carcinoma treated with tyrosine-kinase-inhibitors (TKIs). In 93 patients with metastatic renal cell carcinoma, sarcopenia was assessed based on manually assisted software measurements of sarcopenia indices based on different muscle areas. Whole muscle area and psoas muscle area at L3 were estimated and adjusted to patient's height in routine CT imaging before the start of first-line TKI therapy. The correlation of different sarcopenia definitions to overall survival was investigated in a univariate analysis as well as in a multivariate analysis. The mean patients' age at inclusion was 65.8 years (21-86 years). Median survival was 12.3 months (IQR: 5.7-29.8 months), and mean survival was 18.8 months (SD: 17.2 months). As the definitions of sarcopenia differ considerably, 7.6% to 96.7% of the patients were classified as sarcopenic. In univariate analysis, sarcopenia was significantly associated with overall survival. Multivariate analysis, taking into account the Memorial Sloan Kettering Cancer Center risk score, revealed that some sarcopenia-indices are additional and independent prognostic markers. The risk of death was approximately doubled in sarcopenic patients. Sarcopenia is an important prognostic factor in patients with metastatic renal cell carcinoma treated with TKIs. Multivariate analysis demonstrates a doubling of the risk of death in sarcopenic patients. The assessment of sarcopenia can be performed by the analysis of routine staging imaging using indices of the total muscle area or the psoas muscle area.

Genetic Variants, Serum 25-Hydroxyvitamin D Levels, and Sarcopenia

Vitamin D deficiency is commonly associated with sarcopenia; however, the latest International Clinical Practice Guidelines for Sarcopenia do not recommend vitamin D supplementation for sarcopenia owing to a lack of an apparent therapeutic effect on the indices of sarcopenia among participants with replete vitamin D concentration (ie, 25-hydroxyvitamin D [25(OH)D] level >20 ng/mL) from randomized clinical trials. While there is consensus in all vitamin D guidelines that serum levels of 25(OH)D less than 10 ng/mL should be corrected, approximately 30% of the world population's 25(OH)D levels range from 10 to 20 ng/mL, and it remains unclear whether such suboptimal levels can maintain optimal health, including sarcopenia risk. To investigate the association of serum 25(OH)D level, especially suboptimal levels, with sarcopenia risk. This genome-wide genetic association study was performed from August 2022 to February 2023 among the 295 489 unrelated European participants from the UK Biobank (2006-2010). Nonlinear and standard mendelian randomization analyses were used to examine the association of serum 25(OH)D concentration with sarcopenia risk. A weighted genetic risk score using 35 unrelated single-nucleotide variants from the UK Biobank and weights from the SUNLIGHT Consortium was selected as an instrumental variable for serum 25(OH)D concentration. The primary outcome was sarcopenia, and the secondary outcomes consisted of grip strength, appendicular lean mass index, and gait speed. The final genetic analyses included 295 489 participants (mean [SD] age, 56.3 [8.1] years; 139 216 female [52.9%]). There was an L-shaped association between genetically predicted serum 25(OH)D concentration and sarcopenia risk. The risk of sarcopenia decreased rapidly as 25(OH)D concentration increased until 20 ng/mL and then leveled off. The odds ratio of sarcopenia for serum 25(OH)D level of 10 vs 20 ng/mL was 1.74 (95% CI, 1.17-2.59). Similar patterns were also observed when the association between serum 25(OH)D concentration and risks of each of the sarcopenia indices were evaluated. In this mendelian randomization genetic association study of adults in the UK Biobank, the findings supported a nonlinear association between suboptimal 25(OH)D levels and sarcopenia risk. Randomized clinical trials among participants with suboptimal 25(OH)D levels are required to verify the potential causality.