Department of Surgery, South Auckland Clinical Campus, The University of Auckland, New Zealand.
Department of Surgery, South Auckland Clinical Campus, The University of Auckland, New Zealand.
Injury. 2019 Sep;50(9):1565-1576. doi: 10.1016/j.injury.2019.07.001. Epub 2019 Jul 2.
Sarcopenia is the progressive loss of skeletal muscle mass, strength and general decline in function associated with age, and has previously been shown to be a predictor of poor outcomes following surgery. Computed tomography (CT)-assessed sarcopenia has been proposed to be an independent predictor of outcomes for trauma patients. This systematic review aims to determine the impact of CT-assessed sarcopenia on patient mortality following trauma.
A systematic review and meta-analysis of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, MEDLINE and CENTRAL databases were searched from database inception to 26 November 2018. Bibliographies of included articles were hand searched for potential articles. All observational studies which included trauma patients who had skeletal muscle mass or density assessed by CT were included in the review. Two authors independently performed the search with decisions reached by consensus. Meta-analysis was performed using Review Manager v5.3 using a random effects model. The primary outcome was all cause mortality, as established a priori.
Following an initial search of 1984 records, a total of 20 retrospective observational studies were included for qualitative analysis. Ten of these studies consisting of a pooled, partly-overlapping, 2867 patients were included in the meta-analysis. There was a wide variation in the reported prevalence of sarcopenia (25.0-71.1%). Sarcopenia patients were at a significantly increased risk of mortality during inpatient stay (RR 1.96 [95%CI 1.30-2.94], p = 0.001), at 30 days (RR 1.60 [95%CI 1.21-2.13], p = 0.001) and at 1-year (RR 3.11 [95%CI 1.94-4.96], p < 0.00001). There was no significant difference in total complications encountered, ICU duration or total inpatient stay.
Sarcopenia identified by CT is associated with increased risk of inpatient, 30-day, and 1-year mortality in trauma patients.
肌少症是一种与年龄相关的骨骼肌质量、力量和功能普遍下降的进行性损失，先前已被证明是手术后不良结局的预测因素。计算机断层扫描（CT）评估的肌少症已被提出是创伤患者结局的独立预测因素。本系统评价旨在确定 CT 评估的肌少症对创伤后患者死亡率的影响。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对文献进行系统评价和荟萃分析。从数据库建立到 2018 年 11 月 26 日，在 EMBASE、MEDLINE 和 CENTRAL 数据库中进行了搜索。纳入文章的参考文献也进行了手工搜索，以寻找潜在的文章。所有纳入的观察性研究均包括通过 CT 评估骨骼肌质量或密度的创伤患者。两名作者独立进行了搜索，决策由共识达成。使用 Review Manager v5.3 进行荟萃分析，采用随机效应模型。主要结局是预先确定的全因死亡率。
最初搜索了 1984 条记录后，共纳入 20 项回顾性观察性研究进行定性分析。其中 10 项研究包括一个汇总的、部分重叠的 2867 例患者，纳入荟萃分析。肌少症的报告患病率差异很大（25.0-71.1%）。肌少症患者在住院期间（RR 1.96 [95%CI 1.30-2.94]，p=0.001）、30 天（RR 1.60 [95%CI 1.21-2.13]，p=0.001）和 1 年（RR 3.11 [95%CI 1.94-4.96]，p<0.00001）时的死亡率显著增加。总并发症发生率、ICU 持续时间或总住院时间无显著差异。
CT 识别的肌少症与创伤患者住院、30 天和 1 年死亡率增加相关。
