TY - JOUR
T1 - Effect of muscle depletion on survival in peripheral arterial occlusive disease
T2 - Quality over quantity
AU - Vedder, Issi R
AU - Levolger, Stef
AU - Dierckx, Rudi A J O
AU - Zeebregts, Clark J
AU - de Vries, Jean-Paul P M
AU - Viddeleer, Alain R
AU - Bokkers, Reinoud P H
N1 - Copyright © 2020. Published by Elsevier Inc.
PY - 2020/12
Y1 - 2020/12
N2 - Objective: Patients with peripheral arterial occlusive disease (PAOD) have a poor prognosis and a high prevalence of comorbidity. This study investigated whether sarcopenia and/or myosteatosis negatively affect long-term survival in patients with PAOD.Methods: This was a single-center, retrospective cohort study of 686 consecutive patients diagnosed and treated for PAOD and who underwent computed tomography scanning. Cross-sectional muscle measurements were obtained at the level of the third lumbar vertebra. Optimal stratification was used to define sex-specific and body mass index-specific cutoff values for sarcopenia and myosteatosis, respectively. The Cox proportional hazards model was used to determine the effect of sarcopenia and myosteatosis on overall survival.Results: Sarcopenia was associated with age, body mass index, myosteatosis, malignancy, congestive heart failure, hemodialysis, and Fontaine 4 classification. Myosteatosis was associated with age, sarcopenia, type 2 diabetes mellitus, hypertension, chronic obstructive pulmonary disease, malignancy, congestive heart failure, ischemic stroke, and Fontaine 4 classification. Sarcopenia (hazard ratio [HP], 2.82; 95% confidence interval [CI], 2.05-3.86; P <.001) and myosteatosis (HR, 4.13; 95% CI, 3.03-5.63; P <.001) were both associated with reduced survival in univariable analysis. When adjusted for other prognostic markers, myosteatosis (HR, 2.09; 95% CI, 1.46-2.99; P <.001) was still associated with lower overall survival in the multivariable model, but sarcopenia (HR, 1.40; 95% CI, 0.97-2.01; P=.073) was not.Conclusions: Muscle depletion is independently associated with a poorer overall survival in patients with PAOD. Myosteatosis is a stronger predictor than sarcopenia, which indicates that quality is more important than quantity. Results should be interpreted with caution owing to missing data on medication usage.
AB - Objective: Patients with peripheral arterial occlusive disease (PAOD) have a poor prognosis and a high prevalence of comorbidity. This study investigated whether sarcopenia and/or myosteatosis negatively affect long-term survival in patients with PAOD.Methods: This was a single-center, retrospective cohort study of 686 consecutive patients diagnosed and treated for PAOD and who underwent computed tomography scanning. Cross-sectional muscle measurements were obtained at the level of the third lumbar vertebra. Optimal stratification was used to define sex-specific and body mass index-specific cutoff values for sarcopenia and myosteatosis, respectively. The Cox proportional hazards model was used to determine the effect of sarcopenia and myosteatosis on overall survival.Results: Sarcopenia was associated with age, body mass index, myosteatosis, malignancy, congestive heart failure, hemodialysis, and Fontaine 4 classification. Myosteatosis was associated with age, sarcopenia, type 2 diabetes mellitus, hypertension, chronic obstructive pulmonary disease, malignancy, congestive heart failure, ischemic stroke, and Fontaine 4 classification. Sarcopenia (hazard ratio [HP], 2.82; 95% confidence interval [CI], 2.05-3.86; P <.001) and myosteatosis (HR, 4.13; 95% CI, 3.03-5.63; P <.001) were both associated with reduced survival in univariable analysis. When adjusted for other prognostic markers, myosteatosis (HR, 2.09; 95% CI, 1.46-2.99; P <.001) was still associated with lower overall survival in the multivariable model, but sarcopenia (HR, 1.40; 95% CI, 0.97-2.01; P=.073) was not.Conclusions: Muscle depletion is independently associated with a poorer overall survival in patients with PAOD. Myosteatosis is a stronger predictor than sarcopenia, which indicates that quality is more important than quantity. Results should be interpreted with caution owing to missing data on medication usage.
KW - PAOD
KW - Sarcopenia
KW - Myosteatosis
KW - Intramuscular fat
KW - Survival
KW - Outcome
KW - SKELETAL-MUSCLE
KW - PROGNOSTIC-FACTOR
KW - ELDERLY-MEN
KW - SARCOPENIA
KW - MASS
KW - INFLAMMATION
KW - ASSOCIATION
KW - MANAGEMENT
KW - MORTALITY
KW - ADHERENCE
U2 - 10.1016/j.jvs.2020.03.050
DO - 10.1016/j.jvs.2020.03.050
M3 - Article
C2 - 32330596
SN - 0741-5214
VL - 72
SP - 2006-2016.e1
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 6
ER -