Puccioni Caterina, Fransvea Pietro, Rodolfino Elena, Cintoni Marco, Vacca Alessandro, Benedetto Dario, Mele Maria Cristina, Sganga Gabriele
UOC Chirurgia d'Urgenza e del Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
J Clin Med. 2024 Dec 24;14(1):7. doi: 10.3390/jcm14010007.
Acute diverticulitis (AD), an inflammatory complication of diverticulosis, affects around 4% of individuals with diverticulosis, with increased incidence in older populations. This study aims to assess the impact of sarcopenia, the age-related loss of muscle mass, on the clinical decision-making and outcomes of patients with AD. A retrospective study was conducted on 237 patients admitted to the Emergency Department (ED) between January 2014 and February 2022. Patients diagnosed with AD Hinchey ≥ 2 via contrasted tomography (CT) were included. Sarcopenia was assessed using CT scans at the third lumbar vertebra (L3), with skeletal muscle area (SMA) normalized by height to calculate the skeletal muscle index (SMI). Patients were divided into two groups based on sarcopenia status and analysed for surgical outcomes, non-operative management (NOM) success, and complications. The prevalence of sarcopenia was 46%. Sarcopenic patients were significantly older and had lower BMI and higher frailty scores. A higher proportion of sarcopenic patients underwent Hartmann, while non-sarcopenic patients more often had anastomosis. Sarcopenia did not significantly affect overall morbidity, mortality, or the failure rate of NOM. However, sarcopenic patients with a BMI > 25 had a higher likelihood of requiring redo surgeries. Sarcopenia plays a critical role in the surgical management of AD but does not predict worse clinical outcomes. The decision to perform surgery, particularly Hartmann's procedure, is influenced by sarcopenia, yet morbidity and mortality rates are comparable between sarcopenic and non-sarcopenic patients. These findings highlight the need for sarcopenia to be considered in preoperative assessments.
急性憩室炎（AD）是憩室病的一种炎症性并发症，约4%的憩室病患者会受到影响，且在老年人群中的发病率更高。本研究旨在评估肌肉减少症（与年龄相关的肌肉量流失）对AD患者临床决策和预后的影响。对2014年1月至2022年2月期间急诊科收治的237例患者进行了一项回顾性研究。纳入通过对比增强计算机断层扫描（CT）诊断为AD Hinchey≥2级的患者。使用第三腰椎（L3）的CT扫描评估肌肉减少症，通过身高对骨骼肌面积（SMA）进行标准化以计算骨骼肌指数（SMI）。根据肌肉减少症状态将患者分为两组，并分析手术结果、非手术治疗（NOM）成功率和并发症。肌肉减少症的患病率为46%。肌肉减少症患者年龄显著更大，体重指数（BMI）更低，衰弱评分更高。更高比例的肌肉减少症患者接受了哈特曼手术，而非肌肉减少症患者更常进行吻合术。肌肉减少症对总体发病率、死亡率或NOM失败率没有显著影响。然而，BMI>25的肌肉减少症患者需要再次手术的可能性更高。肌肉减少症在AD的手术治疗中起关键作用，但不能预测更差的临床结果。进行手术的决定，尤其是哈特曼手术，受肌肉减少症影响，但肌肉减少症患者和非肌肉减少症患者的发病率和死亡率相当。这些发现凸显了在术前评估中考虑肌肉减少症的必要性。
