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Sarcopenia and myosteatosis predict adverse outcomes after emergency laparotomy: a multi-centre observational cohort study

Sarcopenia and myosteatosis predict adverse outcomes after emergency laparotomy: a multi-centre observational cohort study
Sarcopenia and myosteatosis predict adverse outcomes after emergency laparotomy: a multi-centre observational cohort study

Objective:To determine the relationship between BC, specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.Background:Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however, evidence is lacking in emergency surgery.Methods:An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using preoperative computed tomography images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modeling.Results:Six hundred ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs 45.1%, P = 0.028; 57.5% vs 42.6%, P = 0.014), 30-day (9.5% vs 3.6%, P = 0.010; 14.9% vs 3.4%, P < 0.001), and 1-year mortality (27.4% vs 11.5%, P < 0.001; 29.7% vs 12.5%, P < 0.001). Risk-Adjusted 30-day mortality was significantly increased by sarcopenia [OR 2.56 (95% CI 1.12-5.84), P = 0.026] and myosteatosis [OR 4.26 (2.01-9.06), P < 0.001], similarly at 1-year [OR 2.66 (95% CI 1.57-4.52), P < 0.001; OR2.08 (95%CI 1.26-3.41), P = 0.004]. BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95% CI 0.835-0.84).Conclusion:Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.

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Body, Samantha
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Ligthart, Marjolein A. P.
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Rahman, Saqib
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Curtis, Nathan J.
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West, Malcolm A.
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Airofarulla, Clizia
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Lee, Chui
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Mercer, Stuart
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Damink, Steven W. M. Olde
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Pearson, Katherine
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Primrose, John N.
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Robinson, Paul
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Sorensen, Eva
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Stubbs, Benjamin M.
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Suhail, Noori
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Underwood, Timothy J.
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Wessex Research Collaborative
Body, Samantha
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Ligthart, Marjolein A. P.
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Rahman, Saqib
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Ward, James
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May-miller, Peter
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Pucher, Philip H.
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Curtis, Nathan J.
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West, Malcolm A.
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Airofarulla, Clizia
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Alder, Louise
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Baylem, Nicholas
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Berry, David
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Bhuvanakrishna, Thakshyanee
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Bond, Amanda
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Booth, Richard
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Broadhurst, Jack
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Byrne, James P.
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Carten, Rachel
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Chambler, Duncan
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Davis, Heather
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Edwards, Mark R.
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Froggatt, Paul
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Francis, Nader
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Lee, Gui Han
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Hickish, Camilla
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Howse, Frances
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Damink, Steven W. M. Olde
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Primrose, John N.
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Robinson, Paul
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Tzivanakis, Alexios
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Underwood, Timothy J.
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Body, Samantha, Ligthart, Marjolein A. P., Rahman, Saqib, Ward, James, May-miller, Peter, Pucher, Philip H., Curtis, Nathan J., West, Malcolm A., Airofarulla, Clizia, Alder, Louise, Baylem, Nicholas, Berry, David, Benjafield, Anastasia, Bhuvanakrishna, Thakshyanee, Bond, Amanda, Booth, Richard, Broadhurst, Jack, Byrne, James P., Carten, Rachel, Chambler, Duncan, Davis, Heather, Edwards, Mark R., Froggatt, Paul, Francis, Nader, Grocott, Michael P. W., Lee, Gui Han, Levett, Denny Z. H., Hickish, Camilla, Howse, Frances, Kangesu, Prashan, Khawaja, Zeeshan, Lee, Jieyun, Lee, Chui, Mclachlan, Jenny, Mercer, Stuart, Mirnezami, Alex H., Moran, Brendan, Jones, Victoria Morrison, Nicholls, Kate, Damink, Steven W. M. Olde, Pearson, Katherine, Primrose, John N., Robinson, Paul, Sorensen, Eva, Stubbs, Benjamin M., Suhail, Noori, Toh, Simon, Terry, Michael, Tzivanakis, Alexios and Underwood, Timothy J. , Wessex Research Collaborative (2022) Sarcopenia and myosteatosis predict adverse outcomes after emergency laparotomy: a multi-centre observational cohort study. Annals of Surgery, 275 (6), 1103-1111. (doi:10.1097/SLA.0000000000004781).

Record type: Article

Abstract

Objective:To determine the relationship between BC, specifically low skeletal muscle mass (sarcopenia) and poor muscle quality (myosteatosis) and outcomes in emergency laparotomy patients.Background:Emergency laparotomy has one of the highest morbidity and mortality rates of all surgical interventions. BC objectively identifies patients at risk of adverse outcomes in elective cancer cohorts, however, evidence is lacking in emergency surgery.Methods:An observational cohort study of patients undergoing emergency laparotomy at ten English hospitals was performed. BC analyses were performed at the third lumbar vertebrae level using preoperative computed tomography images to quantify skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SM-RA). Sex-specific SMI and SM-RA were determined, with the lower tertile splits defining sarcopenia (low SMI) and myosteatosis (low SM-RA). Accuracy of mortality risk prediction, incorporating SMI and SM-RA variables into risk models was assessed with regression modeling.Results:Six hundred ten patients were included. Sarcopenia and myosteatosis were both associated with increased risk of morbidity (52.1% vs 45.1%, P = 0.028; 57.5% vs 42.6%, P = 0.014), 30-day (9.5% vs 3.6%, P = 0.010; 14.9% vs 3.4%, P < 0.001), and 1-year mortality (27.4% vs 11.5%, P < 0.001; 29.7% vs 12.5%, P < 0.001). Risk-Adjusted 30-day mortality was significantly increased by sarcopenia [OR 2.56 (95% CI 1.12-5.84), P = 0.026] and myosteatosis [OR 4.26 (2.01-9.06), P < 0.001], similarly at 1-year [OR 2.66 (95% CI 1.57-4.52), P < 0.001; OR2.08 (95%CI 1.26-3.41), P = 0.004]. BC data increased discrimination of an existing mortality risk-prediction model (AUC 0.838, 95% CI 0.835-0.84).Conclusion:Sarcopenia and myosteatosis are associated with increased adverse outcomes in emergency laparotomy patients.

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Accepted/In Press date: 20 January 2021
e-pub ahead of print date: 25 February 2021
Published date: 1 June 2022
Additional Information: Funding Information: The authors would like to thank the Wessex Clinical Research Network for supporting the study, and individual research nurses at each recruiting site. No commercial support was involved in the study. This work was undertaken whilst MAW, JNP, and MPWG were funded by the National Institute of Health Research and TJU was funded by Cancer Research UK and the Royal College of Surgeons, England. JNP and MPWG are NIHR Senior Investigators. Funding Information: Funding was provided by the UK National Institute for Health Research, Academic Clinical Lecturer (personal award MAW) CL-206-26-002. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

Identifiers

Local EPrints ID: 446747
URI: http://eprints.soton.ac.uk/id/eprint/446747
ISSN: 0003-4932
PURE UUID: 3720cdf7-100c-4dcb-b0b9-70197d4785d5
ORCID for Malcolm A. West: ORCID iD orcid.org/0000-0002-0345-5356
ORCID for Michael P. W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581
ORCID for John N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605
ORCID for Timothy J. Underwood: ORCID iD orcid.org/0000-0001-9455-2188

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Date deposited: 19 Feb 2021 17:33
Last modified: 04 Nov 2022 05:01

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Contributors

Author: Samantha Body
Author: Marjolein A. P. Ligthart
Author: Saqib Rahman
Author: James Ward
Author: Peter May-miller
Author: Philip H. Pucher
Author: Nathan J. Curtis
Author: Malcolm A. West ORCID iD
Author: Clizia Airofarulla
Author: Louise Alder
Author: Nicholas Baylem
Author: David Berry
Author: Anastasia Benjafield
Author: Thakshyanee Bhuvanakrishna
Author: Amanda Bond
Author: Richard Booth
Author: Jack Broadhurst
Author: James P. Byrne
Author: Rachel Carten
Author: Duncan Chambler
Author: Heather Davis
Author: Mark R. Edwards
Author: Paul Froggatt
Author: Nader Francis
Author: Gui Han Lee
Author: Denny Z. H. Levett
Author: Camilla Hickish
Author: Frances Howse
Author: Prashan Kangesu
Author: Zeeshan Khawaja
Author: Jieyun Lee
Author: Chui Lee
Author: Jenny Mclachlan
Author: Stuart Mercer
Author: Alex H. Mirnezami
Author: Brendan Moran
Author: Victoria Morrison Jones
Author: Kate Nicholls
Author: Steven W. M. Olde Damink
Author: Katherine Pearson
Author: Paul Robinson
Author: Eva Sorensen
Author: Benjamin M. Stubbs
Author: Noori Suhail
Author: Simon Toh
Author: Michael Terry
Author: Alexios Tzivanakis
Corporate Author: Wessex Research Collaborative

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