血清肌酐/胱抑素 C 比值作为肌少症的筛查工具和食管癌患者的预后指标。

Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer.

机构信息

Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.

McMaster University, Hamilton, Canada.

出版信息

BMC Geriatr. 2022 Mar 15;22(1):207. doi: 10.1186/s12877-022-02925-8.

BACKGROUND & AIMS: Sarcopenia is associated with poor clinical outcomes of patients who underwent esophagectomy. The current diagnostic criteria for sarcopenia are complex and laborious. We aimed to employ the simple and economic indicator sarcopenia index (SI = creatinine/cystatin C ×100) to screen for sarcopenia and to evaluate its prognostic value in patients with esophageal cancer (EC).

METHODS

Older participants in the National health and nutrition examination survey (NHANES) database (1999-2002) were divided into three groups according to tertiles of the SI value to explore the feasibility of SI in the diagnosis of sarcopenia. Restricted cubic spline (RCS) was utilized to show the non-linear relationship between all-cause mortality and SI. Patients with EC admitted to Jinling Hospital were enrolled to validate the efficacy and prognostic value of SI. Cut-off values of SI were determined using receiver operating characteristic curves. Multivariable logistic analyses and Cox analyses were used to identify the independent factors of postoperative complications and long-term survival, respectively.

RESULTS

A total of 989 participants were identified from the NHANES database. SI showed the diagnostic value of sarcopenia (tertile 1 vs. tertile 3: odds ratio [OR]=3.67, 95% confidence interval [CI]: 1.52-8.87, p=0.004; tertile 2 vs. tertile 3: OR=1.79, 95% CI: 0.75-4.28, p=0.191) adjusted for race, gender, and body mass index (BMI). Individuals with SI ≤ 68 had a poorer overall survival (OS) (hazard ratio [HR]=2.14, 95% CI: 1.71-2.68, p<0.001), and the RCS plot showed that the all-cause mortality risk gradually decreased with the increase in SI. Then, 203 patients with EC were enrolled, of which 76 patients were diagnosed with sarcopenia. There was a linear correlation between SI and skeletal muscle index and prealbumin, indicating that SI was reliable for diagnosing sarcopenia. Patients in the high sarcopenia risk group (Male: SI < 62; Female: SI < 55) showed a higher incidence of complications (OR=3.50, 95% CI: 1.85-6.61, p<0.001) and poorer long-term survival (HR=2.62, 95% CI: 1.02-6.77, p=0.046).

CONCLUSION

SI could be used to identify sarcopenia in patients with EC, and it is a useful prognostic factor of postoperative complications and long-term survival.

背景与目的

肌少症与接受食管切除术的患者的临床结局不良相关。目前肌少症的诊断标准复杂且繁琐。我们旨在使用简单且经济的指标肌少症指数（SI = 肌酐/胱抑素 C ×100）来筛查肌少症，并评估其在食管癌（EC）患者中的预后价值。

方法

根据 SI 值的三分位数将国家健康和营养检查调查（NHANES）数据库（1999-2002 年）中的老年参与者分为三组，以探讨 SI 在肌少症诊断中的可行性。限制性三次样条（RCS）用于显示全因死亡率和 SI 之间的非线性关系。纳入南京金陵医院收治的 EC 患者，以验证 SI 的疗效和预后价值。使用受试者工作特征曲线确定 SI 的截断值。多变量逻辑分析和 Cox 分析分别用于确定术后并发症和长期生存的独立因素。

结果

从 NHANES 数据库中确定了 989 名参与者。SI 显示出肌少症的诊断价值（三分位 1 与三分位 3：比值比[OR] = 3.67，95%置信区间[CI]：1.52-8.87，p=0.004；三分位 2 与三分位 3：OR=1.79，95% CI：0.75-4.28，p=0.191），调整了种族、性别和体重指数（BMI）。SI≤68 的个体总体生存率（OS）较差（风险比[HR]=2.14，95% CI：1.71-2.68，p<0.001），RCS 图显示全因死亡率风险随 SI 增加而逐渐降低。然后，纳入了 203 名 EC 患者，其中 76 名被诊断为肌少症。SI 与骨骼肌指数和前白蛋白之间存在线性相关性，表明 SI 可可靠地诊断肌少症。高肌少症风险组（男性：SI<62；女性：SI<55）的患者并发症发生率更高（比值比[OR]=3.50，95% CI：1.85-6.61，p<0.001），长期生存情况更差（风险比[HR]=2.62，95% CI：1.02-6.77，p=0.046）。