Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
Department of Vascular Surgery, NHS Tayside, Dundee, UK.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae114.
Sarcopenia appears to be associated with inferior outcomes in surgical conditions. Chronic systemic inflammation confers an inferior long-term prognosis in cardiovascular disease and is associated with the development of sarcopenia. The aim of this study was to describe the prognostic role of sarcopenia assessed using computed tomography (CT)-derived body composition analysis and systemic inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis.
In this retrospective cohort study, patients undergoing carotid endarterectomy for symptomatic carotid stenosis between 1 January 2011 and 1 October 2021 at four referral centres were included. The C3 skeletal muscle index and C3 skeletal muscle density were recorded from preoperative CT images. Systemic inflammation was assessed using the preoperative systemic inflammatory grade (SIG). The primary outcome was overall mortality during the study interval.
A total of 618 patients were included, with a median follow-up of 69 (interquartile range 34-85) months. On univariable analysis, age greater than or equal to 75 years (P < 0.001), American Society of Anesthesiologists (ASA) grade greater than II (P < 0.001), low C3 skeletal muscle index (P = 0.002), low C3 skeletal muscle density (P < 0.001), SIG greater than or equal to 2 (P < 0.001), and low L3 derived skeletal muscle index (P < 0.001) were associated with increased mortality, whereas body mass index greater than or equal to 25 kg/m2 was associated with decreased mortality (P = 0.023). On multivariable analysis, age 75 years or older (HR 2.17 (95% c.i. 1.58 to 2.97), P < 0.001), ASA grade greater than II (HR 2.06 (95% c.i. 1.35 to 3.12), P < 0.001), low C3 skeletal muscle density (HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001), and SIG greater than or equal to 2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001) were independently associated with increased mortality.
Cervical CT-derived muscle mass and density, and markers of systemic inflammation, such as systemic inflammatory grade, may be associated with an inferior long-term prognosis after carotid endarterectomy.
肌肉减少症似乎与手术结果不良有关。慢性全身炎症会导致心血管疾病的长期预后不佳，并与肌肉减少症的发展相关。本研究的目的是描述使用计算机断层扫描（CT）衍生的身体成分分析和全身炎症评估的肌肉减少症在因有症状颈动脉狭窄而接受颈动脉内膜切除术的患者中的预后作用。
在这项回顾性队列研究中，纳入了 2011 年 1 月 1 日至 2021 年 10 月 1 日期间在四个转诊中心因有症状颈动脉狭窄而接受颈动脉内膜切除术的患者。从术前 CT 图像中记录 C3 骨骼肌指数和 C3 骨骼肌密度。全身炎症使用术前全身炎症等级（SIG）进行评估。主要结局是研究期间的总死亡率。
共纳入 618 例患者，中位随访时间为 69（四分位距 34-85）个月。单变量分析显示，年龄≥75 岁（P < 0.001）、美国麻醉医师学会（ASA）分级> II 级（P < 0.001）、C3 骨骼肌指数低（P = 0.002）、C3 骨骼肌密度低（P < 0.001）、SIG≥2（P < 0.001）和 L3 衍生骨骼肌指数低（P < 0.001）与死亡率增加相关，而 BMI≥25kg/m2 与死亡率降低相关（P = 0.023）。多变量分析显示，年龄≥75 岁（HR 2.17（95%可信区间 1.58 至 2.97），P < 0.001）、ASA 分级> II 级（HR 2.06（95%可信区间 1.35 至 3.12），P < 0.001）、C3 骨骼肌密度低（HR 1.84（95%可信区间 1.33 至 2.54），P < 0.001）和 SIG≥2（HR 1.63（95%可信区间 1.33 至 1.99），P < 0.001）与死亡率增加独立相关。
颈椎 CT 衍生的肌肉质量和密度以及全身炎症标志物（如全身炎症等级）可能与颈动脉内膜切除术后的长期预后不良相关。
