Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, WA, USA.
Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Scand J Gastroenterol. 2021 Oct;56(10):1175-1181. doi: 10.1080/00365521.2021.1958368. Epub 2021 Aug 3.
Sarcopenia is associated with postoperative complications in inflammatory bowel disease. It has most commonly been defined using the skeletal muscle index, computed after analysis of cross-sectional muscle area at L3. Psoas muscle thickness normalized to height (PMTH), which is easier to derive, is a potential surrogate of SMI and sarcopenia in patients with cirrhosis and chronic pancreatitis. We investigate whether sarcopenia defined by PMTH has utility in predicting post-operative outcomes in patients with inflammatory bowel disease.
We performed a retrospective study of adults undergoing IBD-related surgery from 2009 to 2019 at two hospitals. Sarcopenia was defined by sex-specific PMTH at the umbilicus on cross-sectional imaging using a 50 percentile median cutoff. Predictive models were created using variables (BMI, age, sex, smoking status, albumin, INR, platelets, hemoglobin, hypertension, diabetes, CAD, medications) that may be associated with complications (mortality, reoperation, readmission, transfusions, ICU admission, infection, DVT/PE), and sarcopenia for comparison.
85 patients with IBD were included. Lower albumin level (OR = 0.52, = 0.039) and biologic use (OR = 5.92, = 0.006) were associated with postoperative complications. There was no significant difference using PMTH compared to a model incorporating hypoalbuminemia and biologic use in predicting complications. Sarcopenia on univariate analysis was associated with a lower 30 day rate of reoperation ( = 0.04).
A low status of PMTH was not associated with increased postoperative complications, however hypoalbuminemia and biologic use were. PMTH as a surrogate for sarcopenia requires further study, ideally with prospective studies comparing PMTH with accepted radiographic surrogates for sarcopenia, to determine its role in clinical decision making.
肌少症与炎症性肠病的术后并发症有关。最常见的定义方法是通过分析 L3 处的横截面积计算骨骼肌指数。与肝硬化和慢性胰腺炎患者的骨骼肌指数 (SMI) 和肌少症相比，经身高标准化的腰大肌厚度 (PMTH) 更容易推导，是其潜在的替代指标。我们研究了通过 PMTH 定义的肌少症在预测炎症性肠病患者术后结局中的作用。
我们对两家医院 2009 年至 2019 年间接受 IBD 相关手术的成年人进行了回顾性研究。在横断面成像中，通过脐部的性别特异性 PMTH 使用 50 百分位数中位数截止值来定义肌少症。使用可能与并发症（死亡率、再次手术、再入院、输血、ICU 入院、感染、DVT/PE）相关的变量（BMI、年龄、性别、吸烟状况、白蛋白、INR、血小板、血红蛋白、高血压、糖尿病、CAD、药物）和肌少症来创建预测模型，用于比较。
共纳入 85 例 IBD 患者。较低的白蛋白水平（OR = 0.52， = 0.039）和生物制剂的使用（OR = 5.92， = 0.006）与术后并发症相关。与纳入低白蛋白血症和生物制剂使用的模型相比，使用 PMTH 预测并发症没有显著差异。在单变量分析中，肌少症与较低的 30 天再手术率相关（ = 0.04）。
PMTH 水平较低与术后并发症增加无关，但低白蛋白血症和生物制剂的使用有关。PMTH 作为肌少症的替代指标需要进一步研究，理想情况下需要前瞻性研究将 PMTH 与公认的肌少症放射学替代指标进行比较，以确定其在临床决策中的作用。
