Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
Department of Vascular Surgery, NHS Tayside, Dundee, UK.
J Vasc Surg. 2023 Oct;78(4):937-944.e4. doi: 10.1016/j.jvs.2023.06.012. Epub 2023 Jun 28.
Patient selection and risk stratification for elective repair of abdominal aortic aneurysm (AAA), either by open surgical repair or by endovascular aneurysm repair, remain challenging. Computed tomography (CT)-derived body composition analysis (CT-BC) and systemic inflammation-based scoring systems such as the systemic inflammatory grade (SIG) appear to offer prognostic value in patients with AAA undergoing endovascular aneurysm repair. The relationship between CT-BC, systemic inflammation, and prognosis has been explored in patients with cancer, but data in noncancer populations are lacking. The present study aimed to examine the relationship between CT-BC, SIG, and survival in patients undergoing elective intervention for AAA.
A total of 611 consecutive patients who underwent elective intervention for AAA at three large tertiary referral centers were retrospectively recruited for inclusion into the study. CT-BC was performed and analyzed using the CT-derived sarcopenia score (CT-SS). Subcutaneous and visceral fat indices were also recorded. SIG was calculated from preoperative blood tests. The outcomes of interest were overall and 5-year mortality.
Median (interquartile range) follow-up was 67.0 (32) months, and there were 194 (32%) deaths during the follow-up period. There were 122 (20%) open surgical repair cases, 558 (91%) patients were male, and the median (interquartile range) age was 73.0 (11.0) years. Age (hazard ratio [HR]: 1.66, 95% confidence interval [CI]: 1.28-2.14, P < .001), elevated CT-SS (HR: 1.58, 95% CI: 1.28-1.94, P < .001), and elevated SIG (HR: 1.29, 95% CI: 1.07-1.55, P < .01) were independently associated with increased hazard of mortality. Mean (95% CI) survival in the CT-SS 0 and SIG 0 subgroup was 92.6 (84.8-100.4) months compared with 44.9 (30.6-59.2) months in the CT-SS 2 and SIG ≥2 subgroup (P < .001). Patients with CT-SS 0 and SIG 0 had 90% (standard error: 4%) 5-year survival compared with 34% (standard error: 9%) in patients with CT-SS 2 and SIG ≥2 (P < .001).
Combining measures of radiological sarcopenia and the systemic inflammatory response offers prognostic value in patients undergoing elective intervention for AAA and may contribute to future clinical risk predication strategies.
对于择期修复腹主动脉瘤（AAA）的患者，无论是通过开放手术修复还是通过血管内动脉瘤修复，患者选择和风险分层仍然具有挑战性。基于体成分分析（CT-BC）和全身性炎症的评分系统，如全身炎症等级（SIG），在接受血管内动脉瘤修复的 AAA 患者中似乎具有预后价值。在接受血管内动脉瘤修复的 AAA 患者中，已经探讨了 CT-BC、全身性炎症与预后之间的关系，但在非癌症人群中的数据尚缺乏。本研究旨在探讨 CT-BC、SIG 与接受择期 AAA 干预的患者的生存之间的关系。
回顾性招募了在三个大型三级转诊中心接受择期 AAA 干预的 611 例连续患者，纳入本研究。使用 CT 衍生的肌肉减少症评分（CT-SS）进行 CT-BC 并进行分析。还记录了皮下和内脏脂肪指数。SIG 根据术前血液检查计算得出。感兴趣的结局是总体和 5 年死亡率。
中位（四分位间距）随访时间为 67.0（32）个月，随访期间有 194 例（32%）死亡。有 122 例（20%）行开放手术修复，558 例（91%）为男性，中位（四分位间距）年龄为 73.0（11.0）岁。年龄（风险比 [HR]：1.66，95%置信区间 [CI]：1.28-2.14，P<0.001）、升高的 CT-SS（HR：1.58，95%CI：1.28-1.94，P<0.001）和升高的 SIG（HR：1.29，95%CI：1.07-1.55，P<0.01）与死亡率增加的风险独立相关。CT-SS 0 和 SIG 0 亚组的平均（95%CI）生存率为 92.6（84.8-100.4）个月，而 CT-SS 2 和 SIG≥2 亚组的生存率为 44.9（30.6-59.2）个月（P<0.001）。CT-SS 0 和 SIG 0 的患者 5 年生存率为 90%（标准误差：4%），而 CT-SS 2 和 SIG≥2 的患者为 34%（标准误差：9%）（P<0.001）。
将放射学肌肉减少症和全身性炎症反应的测量结果相结合，可为接受择期 AAA 干预的患者提供预后价值，并可能有助于未来的临床风险预测策略。
