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The association between sarcopenia and adverse outcomes after complex endovascular aortic repair
Britt W Warmerdam1, Carla S van Rijswijk2, Anneke Droop3
1Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Insights
Skeletal Muscle Index (SMI) best predicts mortality risk after complex endovascular aortic repair (EVAR). Combining sarcopenia assessment with physical performance identifies high-risk patients for complex EVAR.
Area of Science:
- Vascular Surgery
- Geriatrics
- Radiology
Background:
- Sarcopenia is a known predictor of poor outcomes following complex endovascular aortic repair (EVAR).
- There is no consensus on the optimal method for assessing sarcopenia in this patient population.
- This study evaluates three computed tomography (CT)-derived sarcopenia parameters.
Purpose of the Study:
- To compare the association of three CT-assessed sarcopenia parameters with adverse outcomes after complex EVAR.
- To determine which parameter, Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), or lean psoas muscle area (LPMA), is most predictive of mortality.
- To investigate the impact of severe sarcopenia and combined physical performance on outcomes.
Main Methods:
- Retrospective cohort study of 101 patients undergoing complex EVAR.
- CT scans were used to measure PMI, SMI, and LPMA.
- Parameters were analyzed as continuous variables and using established cut-off values for sarcopenia diagnosis.
Main Results:
- Higher continuous PMI, SMI, and LPMA were associated with a reduced risk of all-cause mortality.
- Sarcopenia diagnosis using PMI and LPMA cut-offs did not significantly predict survival.
- Sarcopenia diagnosed by SMI showed a significant association with increased mortality risk.
- Severe sarcopenia and sarcopenia combined with low physical performance further increased mortality risk.
Conclusions:
- SMI demonstrated a stronger association with mortality than PMI and LPMA in complex EVAR patients.
- Integrating physical performance measures with sarcopenia assessment can better identify high-risk individuals.
- Further research is needed to establish complex EVAR-specific cut-off values for PMI and LPMA.
Background:
Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR.
Methods:
This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score).
Results:
We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes.
Conclusions:
SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.
