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Impact of Sarcopenia Index on Prognosis in Patients with Chronic Heart Failure
Runlu Sun1, Xiao Liu1, Boshui Huang1
1Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Insights
A low sarcopenia index (SI) may predict a worse prognosis for patients with chronic heart failure (HF). Further research is needed to confirm these findings in larger, prospective studies.
Area of Science:
- Cardiology
- Geriatrics
- Biomarkers
Background:
- The sarcopenia index (SI), derived from the serum creatinine-to-cystatin C ratio, is a recognized marker for sarcopenia.
- Its impact on chronic heart failure (HF) prognosis remains under-investigated.
Purpose of the Study:
- To investigate the association between the sarcopenia index (SI) and clinical outcomes in patients with chronic heart failure (HF).
- To evaluate the predictive performance of SI for all-cause mortality in this population.
Main Methods:
- Retrospective cohort study of 1209 chronic HF patients.
- Cox regression and inverse probability of treatment weighting (IPTW) analyses were employed.
- C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) assessed predictive ability.
Main Results:
- A low SI (≤62.5) was significantly associated with increased all-cause mortality in chronic HF patients (OR 0.42).
- SI demonstrated improved predictive performance for 6-month all-cause mortality (IDI=0.002, p=0.033).
- IPTW analysis showed a trend towards decreased mortality with higher SI, though not statistically significant in this analysis.
Conclusions:
- A low sarcopenia index may indicate a poorer prognosis in chronic heart failure patients.
- Shared pathogenetic pathways exist between heart failure and sarcopenia.
- Validation in larger, prospective studies is recommended.
Background:
The sarcopenia index (SI) was recommended as a surrogate marker of sarcopenia based on the serum creatinine-to-cystatin C ratio, given its accessibility and effectiveness. However, the impact of SI on chronic heart failure (HF) has not been addressed.
Methods:
A total of 1209 chronic HF patients from a retrospective cohort study were included. Cox regression and inverse probability of treatment weighting (IPTW) were used to analyze the impact of the SI on all-cause death and hospitalization. The C-index, net reclassification improvement (NRI), and discrimination improvement (IDI) were used to assess the predictive ability for all-cause death after the addition of SI.
Results:
By IPTW analysis, chronic HF patients with a high SI (SI> 62.5) demonstrated a decreasing trend of 28-day hospital death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422), 3-month death (HR=0.45, 95% CI = 0.06, 3.42, p=0.441) and 6-month death (HR=0.44, 95% CI = 0.06, 3.27, p=0.422) compared with a low SI group (SI≤62.5). The subsequent meta-analysis revealed that a low SI was significantly associated with all-cause mortality (OR 0.42, 95% CI = 0.28, 0.62, I2 = 0, p < 0.0001) in patients with chronic HF. Finally, the SI significantly improved the predictive performance of 6-month allcause mortality in chronic HF patients via the integrated IDI (0.002, 95% CI= 0.00-0.120, p=0.033) but not the C-index (Z statistic=0.116) or NRI (0.114, 95% CI= -0.301--0.263).
Discussion:
Heart failure and sarcopenia share common pathogenetic pathways, including hormonal changes, malnutrition, inflammation and oxidative stress.
Conclusion:
A low SI may indicate a poorer prognosis in patients with chronic heart failure. These findings should be validated in larger, prospective studies.
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