Nana Petroula, Spanos Konstantinos, Brotis Alexandros, Fabre Dominique, Mastracci Tara, Haulon Stephan
Aortic Centre, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France.
Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece.
Eur J Vasc Endovasc Surg. 2023 Apr;65(4):503-512. doi: 10.1016/j.ejvs.2023.01.008. Epub 2023 Jan 16.
Sarcopenia has been related to higher mortality rates after abdominal aortic aneurysm repair. This analysis aimed to assess sarcopenia related mortality and spinal cord ischaemia (SCI) at 30 days, and mortality during the available follow up, in patients with complex aortic aneurysms, managed with open or endovascular interventions.
A search of the English literature, via Ovid, using Medline, EMBASE, and CENTRAL up to 15 June 2022 was done.
This meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and preregistered in PROSPERO (CRD42022338079). Observational studies (2000 - 2022), with five or more patients, reporting on sarcopenia related mortality and SCI at 30 days, and midterm mortality after thoraco-abdominal aneurysm repair (open or endovascular), were eligible. The ROBINS-I tool (Risk Of Bias In Non-Randomised Studies of Interventions) was used for risk of bias, and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for the assessment of evidence quality. The primary outcome was 30 day and midterm mortality, and the secondary outcome was SCI at 30 days, in sarcopenic and non-sarcopenic patients. The outcomes were summarised as odds ratio (OR) with 95% confidence intervals (CIs).
Four retrospective studies (1 092 patients; 40.0% sarcopenic) were included. Thirty day mortality was similar, with low certainty between groups (6% [95% CI 1 - 11] in sarcopenic vs. 5% [95% CI 1 - 9] non-sarcopenic patients [OR 0.30, 95% CI -0.21 - 0.81; p = .94, Ι = 0%). The estimated midterm mortality was statistically significantly higher (very low certainty) in sarcopenic patients (25% [95% CI 0.19 - 0.31] vs. 13% [95% CI -0.03 - 0.29] in non-sarcopenic patients (1.11 OR 0.95, 95% CI -0.21 - 2.44; p < .001, Ι = 88.32%). SCI was significantly higher (very low certainty) in sarcopenic patients (19%, 95% CI 4 - 34) vs. 7% (95% CI 5 - 20) in non-sarcopenic patients (OR 1.80, 95% CI -0.17 - 3.78; Ι = 82.4%), despite an equal distribution of aneurysm type between the groups.
Early mortality does not appear to be affected by sarcopenia in patients treated for thoraco-abdominal aneurysms. However, sarcopenia may be associated with higher peri-operative SCI and midterm mortality rates.
肌肉减少症与腹主动脉瘤修复术后较高的死亡率相关。本分析旨在评估复杂主动脉瘤患者接受开放或血管内干预治疗后30天时与肌肉减少症相关的死亡率和脊髓缺血（SCI），以及在可用随访期间的死亡率。
通过Ovid对英文文献进行检索，使用Medline、EMBASE和CENTRAL截至2022年6月15日的数据。
本荟萃分析按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行，并在PROSPERO（CRD42022338079）中预先注册。纳入2000年至2022年的观察性研究，患者人数为5名或更多，报告肌肉减少症相关的30天死亡率和SCI，以及胸腹主动脉瘤修复（开放或血管内）后的中期死亡率。使用ROBINS-I工具（干预非随机研究中的偏倚风险）评估偏倚风险，使用GRADE（推荐分级、评估、制定和评价）评估证据质量。主要结局是肌肉减少症患者和非肌肉减少症患者的30天和中期死亡率，次要结局是30天时的SCI。结局总结为比值比（OR）及95%置信区间（CI）。
纳入四项回顾性研究（1092例患者；40.0%为肌肉减少症患者）。两组间30天死亡率相似，证据确定性低（肌肉减少症患者为6%[95%CI 1 - 11]，非肌肉减少症患者为5%[95%CI 1 - 9][OR 0.30，95%CI -0.21 - 0.81；p = 0.94，I = 0%]）。肌肉减少症患者的估计中期死亡率在统计学上显著更高（证据确定性极低）（25%[95%CI 0.19 - 0.31]，而非肌肉减少症患者为13%[95%CI -0.03 - 0.29][OR 1.11，95%CI 0.95 - 2.44；p < 0.001，I = 88.32%]）。肌肉减少症患者的SCI显著更高（证据确定性极低）（19%，95%CI 4 - 34），而非肌肉减少症患者为7%（95%CI 5 - 20）（OR 1.80，95%CI -0.17 - 3.78；I = 82.4%），尽管两组间动脉瘤类型分布相同。
胸腹主动脉瘤治疗患者的早期死亡率似乎不受肌肉减少症影响。然而，肌肉减少症可能与围手术期较高的SCI和中期死亡率相关。
