Salisbury NHS Foundation Trust, Salisbury, UK.
Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Ann Surg. 2022 Jun 1;275(6):1103-1111. doi: 10.1097/SLA.0000000000004781. Epub 2021 Feb 25.
To determine the relationship between BC, specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.
Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however, evidence is lacking in emergency surgery.
An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using preoperative computed tomography images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modeling.
Six hundred ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs 45.1%, P = 0.028; 57.5% vs 42.6%, P = 0.014), 30-day (9.5% vs 3.6%, P = 0.010; 14.9% vs 3.4%, P < 0.001), and 1-year mortality (27.4% vs 11.5%, P < 0.001; 29.7% vs 12.5%, P < 0.001). Risk-adjusted 30-day mortality was significantly increased by sarcopenia [OR 2.56 (95% CI 1.12-5.84), P = 0.026] and myosteatosis [OR 4.26 (2.01-9.06), P < 0.001], similarly at 1-year [OR 2.66 (95% CI 1.57-4.52), P < 0.001; OR2.08 (95%CI 1.26-3.41), P = 0.004]. BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95% CI 0.835-0.84).
Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.
确定 BC（具体为低骨骼肌量[肌少症]和肌肉质量差[肌脂化]）与急诊剖腹手术患者结局之间的关系。
急诊剖腹手术是所有外科干预中发病率和死亡率最高的手术之一。BC 客观地确定了择期癌症患者队列中发生不良结局的风险患者，但在急诊手术中缺乏证据。
对十家英国医院的 610 名接受急诊剖腹手术的患者进行了一项观察性队列研究。使用术前计算机断层扫描图像在第三腰椎水平进行 BC 分析，以定量估计骨骼肌指数（SMI）和骨骼肌辐射衰减（SM-RA）。确定了性别特异性 SMI 和 SM-RA，下三分位数的划分定义为肌少症（低 SMI）和肌脂化（低 SM-RA）。使用回归模型评估将 SMI 和 SM-RA 变量纳入风险模型的死亡率风险预测准确性。
纳入 610 例患者。肌少症和肌脂化均与更高的发病率风险相关（52.1%比 45.1%，P = 0.028；57.5%比 42.6%，P = 0.014）、30 天（9.5%比 3.6%，P = 0.010；14.9%比 3.4%，P < 0.001）和 1 年死亡率（27.4%比 11.5%，P < 0.001；29.7%比 12.5%，P < 0.001）。肌少症[比值比（OR）2.56（95%置信区间（CI）1.12-5.84），P = 0.026]和肌脂化[OR 4.26（2.01-9.06），P < 0.001]使调整后的 30 天死亡率显著增加，同样在 1 年时[OR 2.66（95%CI 1.57-4.52），P < 0.001；OR2.08（95%CI 1.26-3.41），P = 0.004]。BC 数据增加了现有死亡率预测模型的区分度（AUC 0.838，95%CI 0.835-0.84）。
肌少症和肌脂化与急诊剖腹手术患者的不良结局增加相关。
