Kathryn Brown MBChB, Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, United Kingdom,
J Nutr Health Aging. 2022;26(8):792-798. doi: 10.1007/s12603-022-1828-2.
Patients with aortic aneurysms (AA) are often co-morbid and susceptible to frailty. Low core muscle mass has been used as a surrogate marker of sarcopenia and indicator of frailty. This study aimed to assess association between core muscle mass with sarcopenia screening tool SARC-F and Clinical Frailty Scale (CFS) in patients with AA.
Prospective audit of patients in pre-operative aortic clinic between 01/07/2019-31/01/2020 including frailty assessment using Rockwood CFS and sarcopenia screening using SARC-F questionnaire. Psoas and sartorius muscle area were measured on pre-operative CT scans and adjusted for height. Association was assessed using Spearman's rank correlation coefficient.
Of 84 patients assessed, median age was 75 years [72,82], 84.5% were men, 65.5% were multimorbid and 63.1% had polypharmacy. Nineteen percent were identified as frail (CFS score >3) and 6.1% positively screened for sarcopenia (SARC-F score 4 or more). Median psoas area (PMA) at L3 was 5.6cm2/m2 [4.8,6.6] and L4 was 7.4cm2/m2 [6.3,8.6]. Median sartorius area (SMA) was 1.8 cm2/m2 [1.5,2.2]. CFS demonstrated weak but statistically significant negative correlation with height-adjusted PMA at L3 (r=-0.25, p=0.034) but not at L4 (r=-0.23, p=0.051) or with SMA (r=-0.22, p=0.065). No association was observed between SARC-F score and PMA or SMA (L3 PMA r=-0.015, p=0.9; L4 PMA r=-0.0014, p= 0.99; SMA r=-0.051, p=0.67).
CFS showed higher association with CT-derived muscle mass than SARC-F. Comprehensive pre-operative risk-stratification tools which incorporate frailty assessment and body composition analysis may assist in decision making for surgery and allow opportunity for pre-habilitation.
患有主动脉瘤（AA）的患者通常合并多种疾病且易出现虚弱。核心肌肉质量低可用作肌少症的替代标志物和虚弱的指标。本研究旨在评估 AA 患者的核心肌肉质量与肌少症筛查工具 SARC-F 和临床虚弱量表（CFS）之间的关联。
对 2019 年 7 月 1 日至 2020 年 1 月 31 日期间在术前主动脉门诊进行的患者进行前瞻性审核，使用 Rockwood CFS 进行虚弱评估，并使用 SARC-F 问卷进行肌少症筛查。在术前 CT 扫描上测量腰大肌和缝匠肌的面积，并按身高进行调整。使用 Spearman 秩相关系数评估相关性。
在评估的 84 名患者中，中位年龄为 75 岁[72，82]，84.5%为男性，65.5%为多种疾病患者，63.1%为多药治疗患者。19%的患者被确定为虚弱（CFS 评分>3），6.1%的患者肌少症筛查阳性（SARC-F 评分 4 或更高）。L3 的中位腰大肌面积（PMA）为 5.6cm2/m2[4.8，6.6]，L4 为 7.4cm2/m2[6.3，8.6]。中位缝匠肌面积（SMA）为 1.8cm2/m2[1.5，2.2]。CFS 与身高调整后的 L3 腰大肌 PMA 呈弱但具有统计学意义的负相关（r=-0.25，p=0.034），但与 L4（r=-0.23，p=0.051）或 SMA（r=-0.22，p=0.065）无相关性。SARC-F 评分与 PMA 或 SMA 之间无相关性（L3 PMA r=-0.015，p=0.9；L4 PMA r=-0.0014，p=0.99；SMA r=-0.051，p=0.67）。
CFS 与 CT 衍生的肌肉质量的相关性高于 SARC-F。综合的术前风险分层工具，纳入虚弱评估和身体成分分析，可能有助于手术决策，并为术前康复提供机会。
