Yajima Takahiro, Yajima Kumiko
Department of Nephrology, Matsunami General Hospital, Gifu, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan.
Ren Fail. 2025 Dec;47(1):2520908. doi: 10.1080/0886022X.2025.2520908. Epub 2025 Jun 23.
We examined the association between computed tomography (CT)-derived paraspinous muscle density (PSMD) and index (PSMI) and all-cause mortality in patients undergoing hemodialysis.
We included 234 hemodialysis patients and used CT images to measure PSMD and PSMI at the third lumbar vertebra level. PSMD and PSMI were determined as the average CT-based value of the paraspinous muscle in Hounsfield units (HUs) and as the paraspinous muscle area adjusted by height (cm/m), respectively. We used univariate and multivariate regression analysis to investigate the associations of PSMD and PSMI with baseline variables. Moreover, we used the Kaplan-Meier methods, Cox regression analysis, and prediction model discrimination to examine the relationships of these paraspinous sarcopenic indices with mortality risk.
The PSMD and PSMI were independently associated with the C-reactive protein level and geriatric nutritional risk index, respectively. The receiver operating curve-derived sex-specific cutoffs of PSMD and PSMI for predicting mortality were 32.1 HU and 13.29 cm/m in women, and 38.4 HU and 14.97 cm/m in men, respectively. Eighty-one patients died during a median follow-up period of 4.0 years. Lower PSMD alone was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR]: 3.14, 95% confidence interval [CI]: 1.81-5.46). In addition, only when PSMD was added to the baseline risk model, the net reclassification improvement significantly improved (0.516, = 0.0001).
PSMD may be better than PSMI for predicting all-cause mortality risk in patients undergoing hemodialysis.
我们研究了计算机断层扫描（CT）得出的椎旁肌密度（PSMD）和指数（PSMI）与接受血液透析患者的全因死亡率之间的关联。
我们纳入了234例血液透析患者，并使用CT图像测量第三腰椎水平的PSMD和PSMI。PSMD和PSMI分别确定为以亨氏单位（HUs）表示的椎旁肌基于CT的平均值，以及按身高（厘米/米）调整的椎旁肌面积。我们使用单变量和多变量回归分析来研究PSMD和PSMI与基线变量之间的关联。此外，我们使用Kaplan-Meier方法、Cox回归分析和预测模型判别来检验这些椎旁肌少肌症指数与死亡风险之间的关系。
PSMD和PSMI分别与C反应蛋白水平和老年营养风险指数独立相关。用于预测死亡率的PSMD和PSMI基于受试者工作曲线得出的性别特异性临界值，女性分别为32.1 HU和13.29厘米/米，男性分别为38.4 HU和14.97厘米/米。在中位随访期4.0年期间，有81例患者死亡。仅较低的PSMD就与全因死亡率风险增加独立相关（调整后的风险比[aHR]：3.14，95%置信区间[CI]：1.81 - 5.46）。此外，仅当将PSMD添加到基线风险模型时，净重新分类改善显著提高（0.516，P = 0.0001）。
在预测接受血液透析患者的全因死亡风险方面，PSMD可能优于PSMI。
