术前胸大肌面积指数与炎症和内毒素血症的生物标志物相关，并可预测左心室辅助装置植入后的临床结局：一项队列研究。

Pre-operative pectoralis muscle area index is associated with biomarkers of inflammation and endotoxemia and predicts clinical outcomes after left ventricular assist device implantation: A cohort study.

机构信息

Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.

Department of Radiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.

出版信息

Artif Organs. 2024 Dec;48(12):1494-1501. doi: 10.1111/aor.14836. Epub 2024 Aug 3.

DOI:10.1111/aor.14836

PMID:39096053

Abstract

BACKGROUND

Pre-left ventricular assist device (LVAD) pectoralis muscle assessment, an estimate of sarcopenia, has been associated with postoperative mortality and gastrointestinal bleeding, though its association with inflammation, endotoxemia, length-of-stay (LOS), and readmissions remains underexplored.

METHODS

This was a single-center cohort study of LVAD patients implanted 1/2015-10/2018. Preoperative pectoralis muscle area was measured on chest computed tomography (CT), adjusted for height squared to derive pectoralis muscle area index (PMI). Those with PMI in the lowest quintile were defined as low-PMI cohort; all others constituted the reference cohort. Biomarkers of inflammation (interleukin-6, adiponectin, tumor necrosis factor-α [TNFα]) and endotoxemia (soluble (s)CD14) were measured in a subset of patients.

RESULTS

Of the 254 LVAD patients, 95 had a preoperative chest CT (median days pre-LVAD: 7 [IQR 3-13]), of whom 19 (20.0%) were in the low-PMI cohort and the remainder were in the reference cohort. Compared with the reference cohort, the low-PMI cohort had higher levels of sCD14 (2594 vs. 1850 ng/mL; p = 0.04) and TNFα (2.9 vs. 1.9 pg/mL; p = 0.03). In adjusted analyses, the low-PMI cohort had longer LOS (incidence rate ratio 1.56 [95% confidence interval 1.16-2.10], p = 0.004) and higher risk of 90-day and 1-year readmissions (subhazard ratio 5.48 [1.88-16.0], p = 0.002; hazard ratio 1.73 [1.02-2.94]; p = 0.04, respectively).

CONCLUSIONS

Pre-LVAD PMI is associated with inflammation, endotoxemia, and increased LOS and readmissions.

摘要

背景

左心室辅助装置（LVAD）术前胸肌评估，即肌少症评估，与术后死亡率和胃肠道出血有关，但其与炎症、内毒素血症、住院时间（LOS）和再入院率的关系仍未得到充分探讨。

方法

这是一项针对 2015 年 1 月至 2018 年 10 月期间植入 LVAD 的患者的单中心队列研究。术前通过胸部计算机断层扫描（CT）测量胸肌面积，通过身高平方进行调整以得出胸肌面积指数（PMI）。PMI 最低五分位数的患者被定义为低 PMI 组；其余的则构成参照组。在一部分患者中还测量了炎症标志物（白细胞介素-6、脂联素、肿瘤坏死因子-α[TNFα]）和内毒素血症（可溶性（s）CD14）标志物。

结果

在 254 名 LVAD 患者中，95 名患者术前进行了胸部 CT（LVAD 前中位数天数：7 [IQR 3-13]），其中 19 名（20.0%）患者为低 PMI 组，其余为参照组。与参照组相比，低 PMI 组的 sCD14（2594 与 1850ng/mL；p=0.04）和 TNFα（2.9 与 1.9pg/mL；p=0.03）水平更高。在调整分析中，低 PMI 组的 LOS 更长（发病率比 1.56 [95%置信区间 1.16-2.10]，p=0.004），90 天和 1 年再入院的风险更高（亚危险比 5.48 [1.88-16.0]，p=0.002；风险比 1.73 [1.02-2.94]；p=0.04）。