Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu, 501-6062, Japan.
Sci Rep. 2021 Sep 24;11(1):19070. doi: 10.1038/s41598-021-98613-5.
Computed tomography (CT)-measured psoas muscle thickness standardized for height (PMTH) has emerged as a promising predictor of mortality. The study aimed to investigate whether PMTH could accurately predict mortality in patients undergoing hemodialysis. We examined 207 patients (mean age: 63.1 years; men: 66.2%) undergoing hemodialysis for more than 6 months in hospital affiliated clinic. PMTH was calculated at the L3 vertebra level using CT. Patients were divided according to the PMTH cut-off points: 8.44 mm/m in women and 8.85 mm/m in men; thereafter, they were combined into low and high PMTH groups. PMTH was independently correlated with the simplified creatinine index (β = 0.213, P = 0.021) and geriatric nutritional risk index (β = 0.295, P < 0.0001) in multivariate regression analysis. During a median follow-up of 3.7 (1.8-6.4) years, 76 patients died, including 41 from cardiovascular causes. In the multivariate Cox regression analysis, low PMTH (adjusted hazard ratio, 2.48; 95% confidence interval, 1.36-4.70) was independently associated with an increased risk of all-cause mortality. The addition of binary PMTH groups to the baseline risk model tended to improve net reclassification improvement (0.460, p = 0.060). In conclusion, PMTH may be an indicator of protein energy wasting and a useful tool for predicting mortality in patients undergoing hemodialysis.
计算机断层扫描（CT）测量的按身高标准化的腰大肌厚度（PMTH）已成为预测死亡率的有前途的指标。本研究旨在探讨 PMTH 是否可以准确预测接受血液透析的患者的死亡率。我们检查了 207 名在医院附属诊所接受血液透析超过 6 个月的患者（平均年龄：63.1 岁；男性：66.2%）。使用 CT 在 L3 椎骨水平计算 PMTH。根据 PMTH 截止点将患者分为：女性 8.44mm/m，男性 8.85mm/m；此后，他们被合并为低 PMTH 和高 PMTH 组。PMTH 与简化肌酐指数（β=0.213，P=0.021）和老年营养风险指数（β=0.295，P<0.0001）在多元回归分析中独立相关。在中位数为 3.7（1.8-6.4）年的随访中，76 名患者死亡，其中 41 名死于心血管原因。在多变量 Cox 回归分析中，低 PMTH（调整后的危险比，2.48；95%置信区间，1.36-4.70）与全因死亡率增加独立相关。将二元 PMTH 组添加到基线风险模型中往往会提高净重新分类改善（0.460，p=0.060）。总之，PMTH 可能是蛋白质能量消耗的指标，也是预测血液透析患者死亡率的有用工具。
