Department of Cardiovascular Surgery, 111319Dr Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Center, Uskudar Turkey.
Department of Cardiovascular Surgery, İstanbul Sultan Abdulhamid Han Research and Training Center, Uskudar Turkey.
Vascular. 2023 Feb;31(1):64-71. doi: 10.1177/17085381211059383. Epub 2022 Jan 3.
We examined the effect of sarcopenia on early surgical outcomes in patients with critical limb ischemia (CLI) in terms of major adverse cardiac events (MACE) and major adverse limb events (MALE), as well as the value of inflammatory markers of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios (PLR) as indicators of sarcopenia in CLI patients.
This was an observational retrospective single-center study. Patients who required surgical revascularization for CLI between October 2015 and December 2020 were identified. Psoas muscle areas were calculated from computed tomography images for psoas muscle index (PMI) calculations. Sarcopenia was defined as PMI < 5.5 cm/m for men and PMI < 4.0 cm/m for women. Risk factors for 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE) were analyzed. NLR and PLR were compared between sarcopenic and non-sarcopenic patients.
The mean age of 217 study patients was 61.5 ± 10.9, and 16 (7.4%) patients were female. 82 (37.8%) patients were sarcopenic. Patients with sarcopenia were older (65.1 ± 9.3 vs 59.4 ± 11.2, < .001) and history of myocardial infarction was more frequent (23.2% vs 12.6%, = 0.042) among sarcopenic patients. Sarcopenic patients more frequently encountered MACE (9.8% vs 0.7%, = 0.002), but not MALE. Sarcopenia increased early postoperative MACE in our cohort with an odds ratio of 11.925. NLR was not different between the two groups, while PLR was higher (127.16 vs 104.06, = 0.010) among sarcopenic patients. The platelet-to-lymphocyte ratio of 125.11 had a sensitivity of 53.7% and a specificity of 68.1% for differentiating sarcopenia.
Sarcopenia was associated with more frequent 30-day MACE and perioperative mortality after revascularization for CLI. 30-day MALE was not increased in patients with sarcopenia. The use of PLR as a simple marker of sarcopenia is limited by its low sensitivity and specificity.
我们研究了在重症肢体缺血（CLI）患者中，肌肉减少症对主要不良心脏事件（MACE）和主要不良肢体事件（MALE）等早期手术结局的影响，以及中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）等炎症标志物作为 CLI 患者肌肉减少症指标的价值。
这是一项观察性回顾性单中心研究。我们确定了 2015 年 10 月至 2020 年 12 月期间因 CLI 而需要手术血运重建的患者。通过计算计算机断层扫描图像的腰大肌面积计算腰大肌指数（PMI）。男性肌肉减少症定义为 PMI<5.5cm/m，女性肌肉减少症定义为 PMI<4.0cm/m。分析了 30 天内主要不良心脏事件（MACE）和主要不良肢体事件（MALE）的危险因素。比较了肌肉减少症和非肌肉减少症患者的 NLR 和 PLR。
217 例研究患者的平均年龄为 61.5±10.9 岁，其中 16 例（7.4%）为女性。82 例（37.8%）患者为肌肉减少症。与非肌肉减少症患者相比，肌肉减少症患者年龄更大（65.1±9.3 岁 vs 59.4±11.2 岁，<0.001）且心肌梗死史更常见（23.2% vs 12.6%，=0.042）。肌肉减少症患者更常发生 MACE（9.8% vs 0.7%，=0.002），但不发生 MALE。肌肉减少症增加了我们队列中患者术后早期的 MACE，其优势比为 11.925。两组间 NLR 无差异，而 PLR 较高（127.16 比 104.06，=0.010）。血小板与淋巴细胞比值为 125.11 时，其区分肌肉减少症的灵敏度为 53.7%，特异性为 68.1%。
在 CLI 患者中，肌肉减少症与血运重建后 30 天内更频繁的 MACE 和围手术期死亡率相关。肌肉减少症患者 30 天内 MALE 发生率并未增加。PLR 作为肌肉减少症的简单标志物，其敏感性和特异性均较低，应用受限。
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