Relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy.

Autor:	Bradley NA; Academic Unit of Surgery, University of Glasgow, Glasgow, UK., Dosanj K; Department of Vascular Surgery, NHS Tayside, Dundee, UK., Chan SYM; Department of Vascular Surgery, NHS Lothian, Edinburgh, UK., Wilson A; Department of Vascular Surgery, NHS Grampian, Aberdeen, UK., Siddiqui T; Department of Vascular Surgery, NHS Lanarkshire, East Kilbride, UK., Forsythe R; Department of Vascular Surgery, NHS Lothian, Edinburgh, UK., Roxburgh CSD; Academic Unit of Surgery, University of Glasgow, Glasgow, UK., McMillan DC; Academic Unit of Surgery, University of Glasgow, Glasgow, UK., Guthrie GJK; Academic Unit of Surgery, University of Glasgow, Glasgow, UK.; Department of Vascular Surgery, NHS Tayside, Dundee, UK.
Jazyk:	angličtina
Zdroj:	BJS open [BJS Open] 2024 Sep 03; Vol. 8 (5).
DOI:	10.1093/bjsopen/zrae114
Abstrakt:	Background: Sarcopenia appears to be associated with inferior outcomes in surgical conditions. Chronic systemic inflammation confers an inferior long-term prognosis in cardiovascular disease and is associated with the development of sarcopenia. The aim of this study was to describe the prognostic role of sarcopenia assessed using computed tomography (CT)-derived body composition analysis and systemic inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis. Methods: In this retrospective cohort study, patients undergoing carotid endarterectomy for symptomatic carotid stenosis between 1 January 2011 and 1 October 2021 at four referral centres were included. The C3 skeletal muscle index and C3 skeletal muscle density were recorded from preoperative CT images. Systemic inflammation was assessed using the preoperative systemic inflammatory grade (SIG). The primary outcome was overall mortality during the study interval. Results: A total of 618 patients were included, with a median follow-up of 69 (interquartile range 34-85) months. On univariable analysis, age greater than or equal to 75 years (P < 0.001), American Society of Anesthesiologists (ASA) grade greater than II (P < 0.001), low C3 skeletal muscle index (P = 0.002), low C3 skeletal muscle density (P < 0.001), SIG greater than or equal to 2 (P < 0.001), and low L3 derived skeletal muscle index (P < 0.001) were associated with increased mortality, whereas body mass index greater than or equal to 25 kg/m2 was associated with decreased mortality (P = 0.023). On multivariable analysis, age 75 years or older (HR 2.17 (95% c.i. 1.58 to 2.97), P < 0.001), ASA grade greater than II (HR 2.06 (95% c.i. 1.35 to 3.12), P < 0.001), low C3 skeletal muscle density (HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001), and SIG greater than or equal to 2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001) were independently associated with increased mortality. Conclusion: Cervical CT-derived muscle mass and density, and markers of systemic inflammation, such as systemic inflammatory grade, may be associated with an inferior long-term prognosis after carotid endarterectomy. (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
Databáze:	MEDLINE
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