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2.
Am J Phys Med Rehabil ; 99(10): 902-908, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32941253

RESUMO

OBJECTIVE: The aim of the study was to explore an individualized sonographic muscle thickness ratio and its cutoff values in the diagnosis of sarcopenia. DESIGN: A total of 326 community-dwelling adults were included in this cross-sectional study. Total skeletal muscle mass was evaluated by bioelectrical impedance analysis, and nine-site muscle thickness measurements using ultrasound. Isometric handgrip and knee extension strengths were assessed. Physical performance was evaluated by usual Gait Speed, Chair Stand Test, and Timed Up and Go Test. RESULTS: Because the anterior thigh muscle thickness was the most significantly decreasing measurement with aging and the most significantly related value with body mass and height; sonographic thigh adjustment ratio was calculated by dividing it with body mass index. Using the two standard deviation values of our healthy young adults, sonographic thigh adjustment ratio cutoff values were found as 1.4 and 1.0 for male and female subjects, respectively. Sonographic thigh adjustment ratio values were negatively correlated with Chair Stand Test and Timed Up and Go Test in both sexes (all P < 0.05) and positively correlated with gait speed in female subjects and knee extension strength in male subjects (both P < 0.05). CONCLUSIONS: Our results imply that regional (rather than total) muscle mass measurements should be taken into consideration for the diagnosis of sarcopenia.


Assuntos
Sarcopenia/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diagnóstico Diferencial , Impedância Elétrica , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia
3.
AJR Am J Roentgenol ; 215(3): 582-594, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755187

RESUMO

OBJECTIVE. The purpose of this article is to review the emerging field of opportunistic CT, which can be used to screen patients for osteoporosis and sarcopenia. CONCLUSION. Although body composition measurements are not routinely obtained using CT, quantitative assessment of bone and muscle biomarkers on CT can add value to patient care. Automated bone and muscle measurements promise to transform the everyday practice of radiology without resulting in additional cost or radiation exposure for patients.


Assuntos
Osteoporose/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biomarcadores , Composição Corporal , Densidade Óssea , Humanos , Programas de Rastreamento/métodos
4.
Clin Interv Aging ; 15: 889-895, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606630

RESUMO

Background: The study aimed to investigate the potential association of trunk skeletal muscle mass (tSM) and phase angle measured by bioelectrical impedance analysis (BIA) with the chance of femoral neck fractures in very elderly people. Patients and Methods: This case-control study enrolled 78 femoral neck fracture patients aged over 75 years (29 males) and 1:2 matched healthy controls. All participants were subjected to BIA examination by specialists. tSM, the corrected values by height squared of tSM (tSMI) and phase angle were compared between fracture patients and controls. Multivariate logistic regression was performed to explore the strength of association of femoral neck fracture with tSM, tSMI, and phase angle. Results: tSM (kg) of fracture patients was significantly lower than those of controls in all participants (women: 13.49±0.42 vs 15.44±0.39, p<0.05; men: 15.30±0.71 vs 17.54±0.78, p<0.05). In the sarcopenic subgroup, fracture patients also got a lower tSM than controls (women: 12.58±0.21 vs 13.62±0.16, p<0.05; men:14.41±0.29 vs 16.07±0.21, p<0.05). The comparison of tSMI between the two groups was similar to that of tSM. Phase angle (°) at 50 kHz in fracture patients was significantly lower than that of controls in women and men (women: 3.70±0.32 vs 4.61±0.21, p<0.05; men: 3.50±0.20 vs 3.84±0.22, p<0.05). Multivariate logistic regression analysis demonstrated higher fracture chance with significantly associated decreased tSM [women: OR (95% CI): 0.78(0.67-0.91); men: 0.74(0.64-0.86)] and tSMI [women: OR (95% CI): 0.72(0.61-0.85); men: 0.69 (0.59-0.81)]. In addition, per 1° increase of phase angle in the trunk could decrease the fracture risk by 14% for women [OR (95% CI): 0.86 0.79-0.94)] and 29% for men [OR (95% CI): 0.71 (0.64-0.79)]. Conclusion: This study indicates a decrease in tSM, tSMI, and phase angle measured by BIA is significantly related to the increased chance of femoral neck fracture in people aged over 75 years. Strengthening the mass and strength of trunk skeletal muscles may help reduce the risk of femoral neck fracture in elderly patients.


Assuntos
Fraturas do Colo Femoral/diagnóstico por imagem , Idoso Fragilizado/estatística & dados numéricos , Músculo Esquelético/patologia , Sarcopenia/patologia , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Impedância Elétrica , Feminino , Fraturas do Colo Femoral/prevenção & controle , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Fatores de Risco , Sarcopenia/diagnóstico por imagem
5.
Int Heart J ; 61(4): 787-794, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684602

RESUMO

Advanced age, obesity, and muscle weakness are independent factors in the onset of deep vein thrombosis (DVT). Recently, an association between sarcopenia and DVT has been reported. We hypothesized that sarcopenia related factors, observed by ultrasonography, are associated with the regression effect on the thrombus following anticoagulation therapy. The present study focused on gastrocnemius muscle (GCM) thickness and the GCM's internal echogenic brightness. We examined the association with DVT regression following direct oral anticoagulants (DOACs) treatment.The prospective cohort study period was between October 2017 and August 2018. We enrolled 46 patients diagnosed with DVT by ultrasonography, who were aged >60 years old and treated with DOACs. Sarcopenia was evaluated using the Asian Working Group for Sarcopenia flowchart. The average DOACs treatment period was 94 days, and 29 patients exhibited thrombus regression. On univariate logistic regression analysis, sarcopenia, average GCM diameter index, and gastrocnemius integrated backscatter index were significantly associated with thrombus regression. In a multivariate model, only the average GCM diameter index correlated with thrombus regression.The average GCM diameter index is associated with DVT regression treated with DOACs. Considering the GCM diameter during DVT treatment can be a marker to make a decision for the treatment of DVT.


Assuntos
Inibidores do Fator Xa/uso terapêutico , Músculo Esquelético/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ultrassonografia , Trombose Venosa/diagnóstico por imagem
6.
Int J Hematol ; 112(1): 46-56, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451786

RESUMO

We analyzed clinical cutoffs for defining computed tomography (CT) methods for sarcopenia and examined the prognostic value of CT for allogeneic hematopoietic stem cell transplantation (allo-HCST) outcomes of patients with myeloid malignancy. One hundred twenty-five adult patients with acute myeloid leukemia and myelodysplastic syndrome who underwent first allo-HSCT between 2000 and 2017 were included. Sarcopenia was assessed using CT-based skeletal muscle index (SMI) and mean muscle attenuation at L3. A statistical difference in SMI was confirmed between sarcopenia (n = 52) and nonsarcopenia (n = 73) patients. There were no significant correlations of muscularity with age, performance status, or other characteristics of HSCT. After 2 years, overall survival (OS) was 43.5% and 70.1%, disease-free survival was 52.9% and 68.6%, nonrelapse mortality (NRM) was 20.8% and 8.4%, incidence of acute GVHD (≥ grade 2) was 38.8% and 39.1%, that of chronic GVHD was 53.2% and 37.3%, and median duration of hospitalization was 88 days and 74 days (P = 0.026), respectively, in the sarcopenia and nonsarcopenia groups. Multivariate analysis showed that presence of sarcopenia is a novel adverse factor for high NRM and poor OS. Pretransplant CT-defined sarcopenia is correlated with decreased OS, increased NRM, and prolonged hospitalization.


Assuntos
Transplante de Células-Tronco Hematopoéticas/mortalidade , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/terapia , Sarcopenia/diagnóstico por imagem , Sarcopenia/etiologia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Transplante Homólogo , Adulto Jovem
7.
Am J Gastroenterol ; 115(6): 859-866, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32235146

RESUMO

OBJECTIVES: Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS: For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS: Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION: Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.


Assuntos
Fragilidade/epidemiologia , Cirrose Hepática/cirurgia , Transplante de Fígado , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/estatística & dados numéricos , Aspiração Respiratória/epidemiologia , Velocidade de Caminhada , Idoso , Extubação , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/cirurgia , Feminino , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Humanos , Intubação Intratraqueal , Avaliação de Estado de Karnofsky , Tempo de Internação , Cirrose Hepática/complicações , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Traqueostomia
8.
Vascular ; 28(5): 542-547, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32295496

RESUMO

OBJECTIVE: This study was performed to determine whether thigh sarcopenia can serve as a clinically relevant predictor of postoperative complications and overall survival after revascularization in patients with critical limb ischemia. METHODS: Patients who underwent preoperative computed tomography followed by infrainguinal revascularization from 2006 to 2015 were retrospectively analyzed. An axial computed tomography image was obtained at the midpoint of a line extending from the superior border of the patella to the greater trochanter of the femur. The thigh muscle area and bone area were measured. Thigh sarcopenia was defined as thigh muscle area/thigh bone area of <9. RESULTS: We included 117 patients with critical limb ischemia who underwent infrainguinal revascularization. The overall survival rates at two years were 86.5% and 55.1% in the thigh sarcopenia (-) and (+) groups, respectively (p < 0.01). The multivariate analysis showed that thigh sarcopenia (hazard ratio, 2.64; 95% confidence interval, 1.11-6.70; p = 0.03), cerebrovascular disease (hazard ratio, 3.18; 95% confidence interval, 1.31-7.36; p = 0.01), and serum albumin level (1 g/dL per increments) (hazard ratio, 0.41; 95% confidence interval, 0.21-0.81; p = 0.01) were the risk factors for overall survival two years after revascularization. CONCLUSION: Thigh sarcopenia is a risk factor for two-year overall survival in patients with critical limb ischemia after infrainguinal revascularization.


Assuntos
Composição Corporal , Hipoalbuminemia/sangue , Isquemia/cirurgia , Músculo Esquelético/fisiopatologia , Doença Arterial Periférica/cirurgia , Sarcopenia/fisiopatologia , Albumina Sérica Humana/análise , Procedimentos Cirúrgicos Vasculares , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estado Terminal , Feminino , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/mortalidade , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/mortalidade , Coxa da Perna , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
9.
Ann Vasc Surg ; 67: 105-114, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32240729

RESUMO

BACKGROUND: This study was performed to determine the association of frailty and comorbidity status with postoperative morbidity and mortality in patients with acute mesenteric ischemia (AMI). METHODS: Patients diagnosed with AMI between April 2006 and September 2019 were enrolled in this study. Frailty was evaluated by sarcopenia which was diagnosed by third lumbar vertebra psoas muscle area (PMA). Comorbidity status was evaluated by the Charlson Comorbidity Index (CCI) score. Univariate and multivariate analyses evaluating the risk factors for postoperative morbidity and mortality were performed. RESULTS: Of the 174 patients, 86 were managed conservatively and 88 underwent surgery. In surgically managed patients, 39.8% developed complications within 30 days of surgery. Ten patients died within 30 days of the operation. In the univariate analyses, white blood cell >10 g/L, low PMA, CCI score ≥2, and bowel resection were associated with postoperative complications. Multivariate analysis revealed that low PMA, CCI score ≥2, and bowel resection were independent predictors of postoperative complications. CONCLUSIONS: This study demonstrated that low PMA, CCI score ≥2, and bowel resection were independent risk factors for postoperative complications in patients with AMI. Preoperative assessment of frailty using PMA and the evaluation of comorbidity status using CCI may serve as helpful tools in preoperative risk assessment and should be integrated into scoring systems for surgically treated AMI.


Assuntos
Regras de Decisão Clínica , Tratamento Conservador , Idoso Fragilizado , Fragilidade/diagnóstico por imagem , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Fatores Etários , Idoso , Composição Corporal , Tomada de Decisão Clínica , Comorbidade , Tratamento Conservador/efeitos adversos , Tratamento Conservador/mortalidade , Procedimentos Cirúrgicos Eletivos , Feminino , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Nível de Saúde , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/mortalidade , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/mortalidade , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Músculos Psoas/fisiopatologia , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
10.
Surg Today ; 50(8): 895-904, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32112159

RESUMO

PURPOSE: Sarcopenia was assessed as a prognostic factor for patients undergoing cardiac surgery by evaluating the quantity and quality of skeletal muscle. METHODS: Sarcopenia was assessed by perioperative abdominal computed tomography using the total psoas muscle index (TPI) and intra-muscular adipose tissue content (IMAC). Patients were classified into high- (HT, n = 143) and low- (LT, n = 63) TPI groups and low- (LI, n = 122) and high- (HI, n = 84) IMAC groups. RESULTS: There were significantly more complications in the LT and HI groups than in the HT and LI groups. (HT 15.4% vs. LT 30.2%, P = 0.014) (LI 11.5% vs. HI 31.1%, P < 0.001). There were more respiratory complications in the LT group (HT 0% vs. LT 6.3%, P = 0.002) and more surgical site infections in the HI group than in the LI group (LI 0.8% vs. HI 7.1%, P = 0.014). A multivariable analysis showed that low TPI and high IMAC significantly predicted more major complications than other combinations (odds ratio [OR] 2.375; 95% confidence interval [CI] 1.152-5.783; P = 0.036, OR 3.973; 95% CI 1.737-9.088; P = 0.001). CONCLUSIONS: Sarcopenia is a risk factor for complications. The quantity and quality of muscle must be assessed to predict operative outcomes. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000027077.


Assuntos
Tecido Adiposo/patologia , Procedimentos Cirúrgicos Cardíacos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Complicações Pós-Operatórias/etiologia , Medição de Risco , Sarcopenia/diagnóstico , Idoso , Feminino , Humanos , Masculino , Período Pré-Operatório , Prognóstico , Fatores de Risco , Sarcopenia/classificação , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Tomografia Computadorizada por Raios X
11.
Clin Orthop Surg ; 12(1): 9-21, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117533

RESUMO

Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.


Assuntos
Osteoporose/diagnóstico por imagem , Osteoporose/terapia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia , Sarcopenia/diagnóstico por imagem , Sarcopenia/terapia , Densidade Óssea , Consolidação da Fratura , Humanos , Incidência , Osteoporose/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/terapia , Fraturas do Rádio/etiologia , Sarcopenia/complicações
12.
Am J Gastroenterol ; 115(4): 584-595, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32141917

RESUMO

OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) and sarcopenia have a close association with an increased risk of atherosclerotic cardiovascular disease (ASCVD). This study investigated the influence of NAFLD and sarcopenia on ASCVD risk. METHODS: Data from the 2008-2011 Korean National Health and Nutrition Examination Surveys database were analyzed (n = 7,191). The sarcopenia index was calculated using dual-energy x-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cutoffs = 0.882 for men and 0.582 for women). NAFLD was defined as a comprehensive NAFLD score ≥40. Liver fibrosis was assessed using the fibrosis-4 (FIB-4) index. ASCVD risk was evaluated using American College of Cardiology/American Heart Association guidelines. High probability of ASCVD was defined as ASCVD risk >10%. RESULTS: The prevalence rates of NAFLD and sarcopenia were 31.2% (n = 2,241) and 19.5% (n = 1,400), respectively. The quartile-stratified ASCVD risk scores were positively associated with NAFLD and sarcopenia (all P for trend < 0.001). Subjects with both NAFLD and sarcopenia had a higher risk for high probability of ASCVD (odds ratio = 1.83, P = 0.014) compared with controls without NAFLD and sarcopenia. Among subjects with NAFLD, FIB-4-defined significant liver fibrosis and sarcopenia additively raised the risk for high probability of ASCVD (odds ratio = 3.56, P < 0.001) compared with controls without FIB-4-defined significant liver fibrosis or sarcopenia. DISCUSSION: NAFLD and sarcopenia were significantly associated with an increased risk of ASCVD in the general population. In addition, NAFLD with significant liver fibrosis and sarcopenia were significantly associated with an increased risk of ASCVD in subjects with NAFLD.


Assuntos
Doenças Cardiovasculares/etiologia , Hepatopatia Gordurosa não Alcoólica/complicações , Sarcopenia/complicações , Absorciometria de Fóton , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Inquéritos Nutricionais , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia
13.
Dis Colon Rectum ; 63(6): 807-815, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32149784

RESUMO

BACKGROUND: Frailty and sarcopenia are important concepts in surgical practice because of their association with adverse postoperative outcomes. Radiologically assessed psoas muscle mass has been proposed as a surrogate for sarcopenia and may be predictive of poor postoperative outcomes. OBJECTIVE: This study aimed to determine the association between sarcopenia, as assessed by psoas cross-sectional area, and postoperative outcomes in patients undergoing colorectal cancer surgery. DESIGN: This was a retrospective review of patient records from 2014 to 2016. SETTINGS: This study was conducted at a single tertiary center. PATIENTS: Patients undergoing elective resection of colorectal cancer were included. MAIN OUTCOME MEASURES: Sarcopenia was assessed using the total psoas index, calculated by measuring the cross-sectional area of the psoas muscle at the third lumbar vertebra and normalized for patient height. Preoperative and intraoperative variables, including the presence of preoperative sarcopenia, were evaluated as potential risk factors for adverse postoperative outcomes. RESULTS: Of 350 patients, 115 (32.9%) were identified as sarcopenic. Sarcopenia was associated with a significantly increased length of stay (13 days vs 7 days; OR, 1.31; 95% CI, 1.23-1.42; p < 0.01) and 1-year mortality (13.9% vs 0.9%; OR, 16.2; 95% CI, 4.34-83.4; p < 0.01). Sarcopenia was also associated with a significant increased risk of any complication (85.2% vs 34.5%; OR, 15.4; 95% CI, 8.39-29.7; p < 0.01) and of major complications (30.4% vs 8.9%; OR, 15.1; 95% CI, 7.16-33.2; p < 0.01). LIMITATIONS: This study was limited by its retrospective design and by being conducted in a single institution. Although reduced muscle mass is suggestive of sarcopenia, it does not assess a patient's physical function or other components of the frailty phenotype. CONCLUSION: Radiological sarcopenia is an important predictive risk factor for adverse postoperative outcomes in surgical patients. Computed tomography scans, which are routinely performed as part of staging, provide an opportunity to assess for sarcopenia preoperatively. See Video Abstract at http://links.lww.com/DCR/B201. LA SARCOPENIA, EVALUADA POR EL ÁREA TRANSVERSAL DE PSOAS, PREDICE RESULTADOS POSTOPERATORIOS ADVERSOS EN PACIENTES SOMETIDOS A CIRUGÍA DE CÁNCER COLORECTAL: La fragilidad y la sarcopenia son conceptos importantes en la práctica quirúrgica debido a su asociación con los resultados postoperatorios adversos. La masa muscular del psoas evaluada radiológicamente se ha propuesto como un sustituto de la sarcopenia y puede predecir resultados postoperatorios deficientes.Determinar la asociación entre la sarcopenia, según lo evaluado por el área transversal del psoas, y los resultados postoperatorios en pacientes sometidos a cirugía de cáncer colorrectal.Esta fue una revisión retrospectiva de los registros de pacientes de 2014 a 2016.Este estudio se llevo a cabo en un solo centro terciario.Se incluyeron pacientes sometidos a resección electiva de cáncer colorrectal.La sarcopenia se evaluó utilizando el índice de psoas total (TPI), calculado midiendo el área de la sección transversal del músculo psoas en la tercera vértebra lumbar y normalizado para la altura del paciente.Se evaluaron las variables preoperatorias e intraoperatorias, incluida la presencia de sarcopenia preoperatoria, como posibles factores de riesgo de resultados postoperatorios adversos.De 350 pacientes, 115 (32,9%) fueron identificados como sarcopénicos. La sarcopenia se asoció con un aumento significativo de la duración de la estancia (13 días frente a 7 días, OR 1.31, IC 95% 1.23-1.42, p < 0.01) y de la mortalidad al año (13.9% vs 0.9%, OR 16.2, IC 95% 4.34-83.4, p < 0.01). La sarcopenia también se asoció con un aumento significativo del riesgo de cualquier complicación (85.2% vs 34.5%, OR 15.4, IC 95% 8.39-29.7, p < 0.01) y de complicaciones mayores (30.4% vs 8.9%, OR 15.1 IC 95% 7.16-33,2, p < 0,01).Este estudio estuvo limitado por su diseño retrospectivo y por el hecho de que se realizó en una sola institución. Aunque la reducción de la masa muscular es un indicio de sarcopenia, no evalúa la función física del paciente ni otros componentes del fenotipo de fragilidad.La sarcopenia radiológica es un importante factor de riesgo predictivo para resultados postoperatorios adversos en pacientes quirúrgicos. Las tomografías computarizadas, que se realizan rutinariamente como parte de la estadificación, brindan la oportunidad de evaluar la sarcopenia antes de la operación. Consulte Video Resumen en http://links.lww.com/DCR/B201. (Traducción-Dr. Gonzalo Hagerman).


Assuntos
Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Músculos Psoas/cirurgia , Sarcopenia/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias Colorretais/complicações , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Fragilidade/epidemiologia , Humanos , Tempo de Internação , Masculino , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prevalência , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Tomografia Computadorizada por Raios X/métodos
14.
J Surg Oncol ; 121(8): 1241-1248, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32162343

RESUMO

BACKGROUND AND OBJECTIVES: Evidence regarding the impact of sarcopenia on operative outcomes in patients with sarcoma is lacking. We evaluated the relationship between sarcopenia and postoperative complications or mortality among patients undergoing tumor excision and reconstruction. ​ METHODS: We retrospectively reviewed 145 patients treated with tumor excision and limb reconstruction for sarcoma of the extremities. Sarcopenia was defined as psoas index (PI) < 5.45 cm2 /m2 for men and <3.85 cm2 /m2 for women from preoperative axial CT. Regression analyses were used to assess the association between postoperative complications or mortality with PI, age, gender, race, body mass index, tumor histology, grade, depth, location, size, and neoadjuvant/adjuvant therapy. RESULTS: There were 101 soft tissue tumors and 44 primary bone tumors. Sarcopenia was present in 38 patients (26%). Sarcopenic patients were older (median age: 72 vs 59 years, P = .0010) and had larger tumors (86.5%, >5 cm vs 77.7%, P = .023). Seventy-three patients experienced complications (51%) and 18 patients died within 1 year. Sarcopenia and metastatic disease were associated with increased 12-month mortality (hazard ratio [HR] = 6.68, P < .001; HR: 8.51, P < .001, respectively) but not complications (HR 1.45, P = .155, odds ratio, 1.32, P = .426, respectively). CONCLUSIONS: Sarcopenia and metastatic disease were independently associated with postoperative mortality but no complications following surgery.


Assuntos
Extremidades/cirurgia , Sarcoma/mortalidade , Sarcoma/cirurgia , Sarcopenia/mortalidade , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/fisiopatologia , Neoplasias Ósseas/cirurgia , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Humanos , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/fisiopatologia , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/fisiopatologia , Adulto Jovem
15.
Eur Radiol ; 30(7): 4091-4097, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32144460

RESUMO

OBJECTIVES: Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI). METHODS: Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6 years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen's kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student's t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements. RESULTS: All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each). CONCLUSION: Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding. KEY POINTS: • Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia. • In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe. • Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.


Assuntos
Imagem por Ressonância Magnética , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Esclerodermia Localizada/diagnóstico por imagem , Esclerodermia Localizada/patologia , Criança , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 99(7): e19059, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049805

RESUMO

Nivolumab, a monoclonal antibody targeting programmed cell death-1, significantly prolongs survival for patients with advanced non-small-cell lung cancer (NSCLC). However, little is known about the value of predictive biomarkers. Hence, we investigated the impact of skeletal muscle (SM) mass loss on clinical outcomes in NSCLC patients undergoing nivolumab treatment. Thirty patients with histologically confirmed NSCLC treated with nivolumab were included in this study. Computed tomography was used to determine SM loss based on the SM index (SMI). The SMI is the cross-sectional area of the bilateral psoas muscles at the third lumbar vertebra, divided by height squared. The cut-off values were defined as 6.36 cm/m for men and 3.92 cm/m for women. Among the 30 patients, 13 (43%) had SM loss. There was no significant association between SM loss and immune-related adverse events. The SM loss group had undergone significantly more prior chemotherapy cycles (P = .04). SM loss was significantly associated with fewer nivolumab cycles (P = .01). No patients in the SM loss group achieved a partial response. Patients with SM loss had a significantly shorter progression-free survival period (P = .008) and median overall survival than those with normal SM mass (10 vs 25 months, respectively, P = .03). SM loss was an independent prognostic factor of poor survival. In conclusion, SM loss may be a predictive factor of poor outcomes in NSCLS patients undergoing nivolumab therapy.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/administração & dosagem , Sarcopenia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Int J Cardiovasc Imaging ; 36(5): 929-938, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32040683

RESUMO

Skeletal muscle mass (SMM) as calculated by computed tomography (CT) is a predictor of all-cause mortality after transcatheter aortic valve replacement (TAVR), but it remains unclear whether using CT-determined density of skeletal muscle has additive prognostic value. We utilized the Japanese multicenter registry data of 1375 patients who underwent CT prior to TAVR. Sarcopenia status was defined by the CT-derived SMM index (threshold: men, 55.4 cm2/m2; women, 38.9 cm2/m2). The threshold for high and low CT density was based on the median value of the entire cohort (men: 33.4 HU; women: 29.5 HU). Sarcopenia was observed in 802 patients (58.3%) overall. Patients were categorized into non-sarcopenia and high-CT density (n = 298), non-sarcopenia and low-CT density (n = 275), sarcopenia and high-CT density (n = 399), and sarcopenia and low-CT density (n = 403) groups, and procedural outcomes and mortality compared. The cumulative 3-year mortality rates in these groups were 18%, 27%, 24%, and 32%, respectively. Cox-regression multivariate analysis revealed that low-CT density (compared with high-CT density) and sarcopenia and low-CT density (compared with non-sarcopenia and high-CT density as reference) increased mortality after TAVR (hazard ratios [HR]: 1.35 and 1.43, 95% confidence intervals [Cis]: 1.06-1.72 and 1.00-2.08, p = 0.01, and 0.049, respectively). However, sarcopenia alone was not related to an increased risk of mortality (HR 1.30, 95% CI 0.99-1.69, p = 0.52). In conclusion, CT density-based skeletal muscle quality assessment combined with the SMM index improves prediction of adverse outcomes after TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Composição Corporal , Avaliação Geriátrica/métodos , Tomografia Computadorizada Multidetectores , Músculo Esquelético/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Japão , Masculino , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
18.
Transplant Proc ; 52(2): 537-539, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32037067

RESUMO

BACKGROUND: Sarcopenia (SP) and preoperative muscle mass are independent predictive factors for short- and long-term outcome of liver transplantation. OBJECTIVE: To assess the influence of muscle mass index (MMI) and preoperative SP on the prognosis of patients who underwent liver transplantation in our hospital. METHODS: Ninety-seven patients who underwent liver transplantation in the Regional University Hospital of Málaga from September 2013 to March 2016 were analyzed. SP was determined based on the MMI, as assessed by psoas muscle area at the L4 level measured by computed tomography (CT), with adjustment for patient sex. Two cohorts were differentiated: 54 patients without SP and 42 patients with SP. Postoperative complications, graft survival, and patient survival were assessed. A 3-year follow-up was carried out. RESULTS: Recipient characteristics were similar in both cohorts, except for MMI ± SD (group without SP: 94.03 ± 15.43 cm2/m2 vs group with SP: 56.99 ± 13.59 cm2/m2; P = .001). The incidence of postoperative complications (Clavien ≥ 3) in patients with and without SP was 39.5% and 24.1%, respectively (P = .08). SP was not associated with poorer long-term graft or patient survival. CONCLUSIONS: SP, determined by preoperative measurement of MMI, was identified as a predictive factor associated with a higher incidence of postoperative complications. Since MMI can be easily determined by CT, it should be assessed in all candidates for liver transplantation.


Assuntos
Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Prognóstico , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/mortalidade , Taxa de Sobrevida
19.
Eur J Radiol ; 125: 108889, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32087468

RESUMO

PURPOSE: Sarcopenia is associated with adverse outcomes in several gastrointestinal malignancies and liver cirrhosis. We aimed to study the utility of magnetic resonance imaging (MRI) derived fat-free muscle area (FFMA) to predict clinical outcome in patients receiving yttrium-90 radioembolization (RE) for treatment of hepatocellular carcinoma (HCC). METHODS: Fifty-eight patients with unresectable HCC and pre-interventional liver MRI undergoing salvage RE were retrospectively evaluated. Using axial T2-weighted turbo spin echo sequences, FFMA was calculated by subtraction of the intramuscular adipose tissue area from the total cross-sectional area of paraspinal skeletal muscles at the superior mesenteric artery level. FFMA values lower than 3582 mm2 in male and 2301 mm2 in female patients were defined as low FFMA. Main outcomes were progression-free survival (PFS) and overall survival (OS). For outcome analysis, the Kaplan-Meier method with log rank test and multivariate cox regression analysis were used. RESULTS: Mean time from pre-interventional MRI to RE was 27 ± 20 days. Median OS and PFS after RE were 250 (range: 21-1230 days) and 156 days (range: 21-674 days), respectively. Patients with low FFMA showed significantly reduced OS (197 vs. 294 days, P = 0.024) and tended to have shortened PFS (109 vs. 185 days, P = 0.068). Low FFMA (HR 2.675; P = 0.011), estimated liver tumor burden (HR 4.058; P = 0.001), and Eastern Cooperative Oncology Group (ECOG) performance status (1.763; P = 0.009) were independent predictors of OS on multivariate analysis. CONCLUSIONS: FFMA as a measure of sarcopenia predicts OS and might represent a promising new biomarker for survival prognosis in patients undergoing RE for treatment of unresectable HCC.


Assuntos
Braquiterapia/métodos , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Imagem por Ressonância Magnética/métodos , Sarcopenia/diagnóstico por imagem , Radioisótopos de Ítrio/uso terapêutico , Idoso , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Masculino , Músculo Esquelético/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Sarcopenia/complicações , Sensibilidade e Especificidade , Análise de Sobrevida , Resultado do Tratamento
20.
World Neurosurg ; 137: e526-e534, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32061954

RESUMO

OBJECTIVE: Sarcopenia is defined as the loss of skeletal muscle mass and is considered an important factor for clinical outcomes in various diseases. Recent studies have shown that temporal muscle thickness (TMT) and area (TMA) can be novel indicators of sarcopenia. We examined clinical characteristics, including TMT and TMA, of patients with subarachnoid hemorrhage (SAH) treated by endovascular coiling. METHODS: A retrospective analysis of 298 patients with SAH who were treated with endovascular coiling from 2009 to 2019 was conducted. Their premorbid modified Rankin Scale (mRS) score was 0-2. The association between the factors and Hunt and Kosnik (H-K) grades on admission and that between the clinical variables and mRS scores 6 months after the operation were analyzed. RESULTS: In all 298 patients with SAH, Fisher group 4 and TMA <200 mm2 were independently associated with H-K grade III-V on admission in the multivariate analysis. In 254 patients with H-K grades I-III on admission, age, H-K grade III, presence of ventriculoperitoneal shunt, presence of postoperative complications, and TMA <200 mm2 were independent factors related to poor outcomes in the multivariate analysis. CONCLUSIONS: The H-K grade on admission was independently associated with TMA. The mRS score 6 months after aneurysm treatment in patients with H-K grades I-III was also independently associated with TMA. Sarcopenia could be one of a few modifiable factors that prevent severe symptoms of SAH and improve outcomes after coiling by strengthened nutrition and physical activity.


Assuntos
Sarcopenia/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Músculo Temporal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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