Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu, 501-6062, Japan.
Sci Rep. 2022 Jun 21;12(1):10496. doi: 10.1038/s41598-022-14927-y.
This study aimed to investigate the associations of computed tomography (CT)-measured psoas muscle index (PMI: psoas muscle area normalized by height) and psoas muscle density (PMD: average of bilateral psoas muscle CT values [Hounsfield unit (HU)]) with mortality in patients undergoing hemodialysis. We included 188 hemodialysis patients who underwent abdominal CT. PMI and PMD were measured at the third lumbar vertebral level. We found that PMI and PMD were independently associated with the geriatric nutritional risk index and log C-reactive protein, respectively. The optimal cut-off values of PMI and PMD for men and women were 3.39 cm/m and 41.6 HU, and 2.13 cm/m and 37.5 HU, respectively. During follow-up (median 3.5 years), 69 patients died. Lower PMI and lower PMD were independently associated with an increased risk of all-cause mortality [adjusted hazard ratio (aHR) 2.05, 95% confidence interval (CI) 1.14-3.68; aHR 3.67, 95% CI 2.04-6.60), respectively]. The aHR for lower PMI and lower PMD vs. higher PMI and higher PMD was 5.34 (95% CI 2.38-11.97). The addition of PMI and PMD to the risk model significantly improved C-index from 0.775 to 0.893 (p < 0.00001). The combination of PMI and PMD may improve mortality prediction in patients undergoing hemodialysis.
本研究旨在探讨 CT 测量的腰大肌指数（PMI：腰大肌面积与身高的比值）和腰大肌密度（PMD：双侧腰大肌 CT 值的平均值[亨氏单位（HU）]）与接受血液透析患者死亡率之间的关系。我们纳入了 188 例接受腹部 CT 检查的血液透析患者。在第三腰椎水平测量 PMI 和 PMD。我们发现，PMI 和 PMD 分别与老年营养风险指数和 log C 反应蛋白独立相关。男性和女性 PMI 和 PMD 的最佳截断值分别为 3.39 cm/m 和 41.6 HU，以及 2.13 cm/m 和 37.5 HU。在随访期间（中位数为 3.5 年），有 69 名患者死亡。较低的 PMI 和 PMD 与全因死亡率增加独立相关[调整后的危险比（aHR）2.05，95%置信区间（CI）1.14-3.68；aHR 3.67，95% CI 2.04-6.60]。较低的 PMI 和 PMD 与较高的 PMI 和 PMD 相比，aHR 为 5.34（95% CI 2.38-11.97）。PMI 和 PMD 的加入显著提高了风险模型的 C 指数，从 0.775 提高到 0.893（p<0.00001）。PMI 和 PMD 的组合可能改善接受血液透析患者的死亡率预测。
