Ghaffarian Amir A, Unangst Jaryd, Bartek Matthew A, Newhall Karina, Kang P Chuhli, Shalhub Sherene, Sweet Matthew P
Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
J Vasc Surg. 2022 Jan;75(1):343-347.e1. doi: 10.1016/j.jvs.2021.08.065. Epub 2021 Sep 24.
Sarcopenia, defined as a loss of muscle mass or poor muscle quality, is a syndrome associated with poor surgical outcomes. The prognostic value of sarcopenia in patients with thoracoabdominal aortic aneurysms (TAAAs) is unknown. The present study was designed to define sarcopenia in this patient population and assess its impact on survival among patients who had undergone operative and nonoperative management of TAAAs.
We retrospectively reviewed all patients with a diagnosis of a TAAA at an academic hospital between 2009 and 2017 who had been selected for operative and nonoperative management. Sarcopenia was identified by measuring the total muscle area on a single axial computed tomography image at the third lumbar vertebra. The muscle areas were normalized by patient height, and cutoff values for sarcopenia were established at the lowest tertile of the normalized total muscle area. Long-term patient survival was assessed using Kaplan-Meier and Cox regression models.
A total of 295 patients were identified, of whom 199 had undergone operative management and 96 nonoperative management for TAAAs. The patients selected for nonoperative management were more likely to be women and to have chronic kidney disease, coronary artery disease, cerebrovascular disease, a higher modified frailty index, and a larger aortic diameter. The Kaplan-Meier analyses revealed significantly lower long-term survival for the patients with and without sarcopenia in the operative and nonoperative groups. In Cox regression analyses, sarcopenia was a significant predictor of shorter survival for both operative (hazard ratio, 0.96; 95% confidence interval, 0.94-0.99; P = .006) and nonoperative (hazard ratio, 0.95; 95% confidence interval, 0.90-1.00; P = .05) groups after adjusting for age, race, sex, maximum aortic diameter, modified frailty index, chronic kidney disease, and active smoking. Additionally, age was a significant predictor of shorter survival in the operative group, and smoking and aortic diameter were significant in the nonoperative group.
In our cohort of patients who had received operative and nonoperative management of TAAAs, the patients with sarcopenia had had significantly lower long-term survival, regardless of whether surgery had been performed. These data suggest that sarcopenia could be used as a predictor of survival for patients with TAAAs and might be useful for risk stratification and decision making in the management of TAAAs.
肌肉减少症定义为肌肉质量丧失或肌肉质量差，是一种与手术效果不佳相关的综合征。肌肉减少症在胸腹主动脉瘤（TAAA）患者中的预后价值尚不清楚。本研究旨在明确该患者群体中的肌肉减少症，并评估其对接受TAAA手术和非手术治疗患者生存情况的影响。
我们回顾性分析了2009年至2017年间在一家学术医院被诊断为TAAA且被选作手术和非手术治疗的所有患者。通过测量第三腰椎水平的单轴计算机断层扫描图像上的总肌肉面积来确定肌肉减少症。肌肉面积按患者身高进行标准化，并将肌肉减少症的临界值设定为标准化总肌肉面积的最低三分位数。使用Kaplan-Meier和Cox回归模型评估患者的长期生存情况。
共确定了295例患者，其中199例接受了TAAA手术治疗，96例接受了非手术治疗。被选作非手术治疗的患者更可能为女性，且患有慢性肾病、冠状动脉疾病、脑血管疾病、改良虚弱指数更高以及主动脉直径更大。Kaplan-Meier分析显示，手术组和非手术组中患有和未患有肌肉减少症的患者长期生存率均显著降低。在Cox回归分析中，在调整年龄、种族、性别、最大主动脉直径、改良虚弱指数、慢性肾病和当前吸烟情况后，肌肉减少症是手术组（风险比，0.96；95%置信区间，0.94 - 0.99；P = .006）和非手术组（风险比，0.95；95%置信区间，0.90 - 1.00；P = .05）生存时间缩短的显著预测因素。此外，年龄是手术组生存时间缩短的显著预测因素，吸烟和主动脉直径是非手术组的显著预测因素。
在我们这个接受TAAA手术和非手术治疗的患者队列中，无论是否进行了手术，患有肌肉减少症的患者长期生存率均显著降低。这些数据表明，肌肉减少症可作为TAAA患者生存情况的预测指标，可能有助于TAAA管理中的风险分层和决策制定。
