Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China
Abstract Background Skeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have sugge...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Journal of Cachexia, Sarcopenia and Muscle |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jcsm.13331 |
| _version_ | 1797375116637634560 |
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| author | Ming‐jie Sheng Jing‐yuan Cao Shi‐mei Hou Min Li Yao Wang Qiang Fang A‐feng Miao Min Yang Shu‐su Liu Chun‐hong Hu Cui‐lan Liu Shi‐yuan Wang Jing Zheng Jing‐jie Xiao Xiao‐liang Zhang Hong Liu Bi‐cheng Liu Bin Wang |
| author_facet | Ming‐jie Sheng Jing‐yuan Cao Shi‐mei Hou Min Li Yao Wang Qiang Fang A‐feng Miao Min Yang Shu‐su Liu Chun‐hong Hu Cui‐lan Liu Shi‐yuan Wang Jing Zheng Jing‐jie Xiao Xiao‐liang Zhang Hong Liu Bi‐cheng Liu Bin Wang |
| author_sort | Ming‐jie Sheng |
| collection | DOAJ |
| description | Abstract Background Skeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have suggested a correlation between CT‐determined skeletal muscle mass and quality at the first lumbar vertebra (L1) level and adverse outcomes. Generally, chest CT does not reach beyond L1. We aimed to determine whether opportunistic CT scan (chest CT)‐determined skeletal muscle mass and quality at L1 are associated with mortality in initial‐dialysis patients. Methods This 3‐year multicentric retrospective study included initial‐dialysis patients from four centres between 2014 and 2017 in China. Unenhanced CT images of the L1 and L3 levels were obtained to assess skeletal muscle mass [by skeletal muscle index, (SMI), cm2/m2] and quality [by skeletal muscle density (SMD), HU]. Skeletal muscle measures at L1 were compared with those at L3. The sex‐specific optimal cutoff values of L1 SMI and L1 SMD were determined in relation to all‐cause mortality. The outcomes were all‐cause death and cardiac death. Cox regression models were applied to investigate the risk factors for death. Results A total of 485 patients were enrolled, of whom 257 had both L1 and L3 images. Pearson's correlation coefficient between L1 and L3 SMI was 0.84 (P < 0.001), and that between L1 and L3 SMD was 0.90 (P < 0.001). No significant association between L1 SMI and mortality was observed (P > 0.05). Low L1 SMD (n = 280, 57.73%) was diagnosed based on the optimal cutoff value (<39.56 HU for males and <33.06 HU for females). Multivariate regression analysis revealed that the low L1 SMD group had higher risks of all‐cause death (hazard ratio 1.80; 95% confidence interval 1.05–3.11, P = 0.034) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007). Conclusions In initial‐dialysis patients, there is high agreement between the L1 and L3 measures for SMI and SMD. Low SMD measured at L1, but not low SMI, is an independent predictor of both all‐cause death and cardiac death. |
| first_indexed | 2024-03-08T19:17:34Z |
| format | Article |
| id | doaj.art-77e0e18a785447ea894884b764beb9b4 |
| institution | Directory Open Access Journal |
| issn | 2190-5991 2190-6009 |
| language | English |
| last_indexed | 2024-03-08T19:17:34Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
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| series | Journal of Cachexia, Sarcopenia and Muscle |
| spelling | doaj.art-77e0e18a785447ea894884b764beb9b42023-12-27T05:05:03ZengWileyJournal of Cachexia, Sarcopenia and Muscle2190-59912190-60092023-12-011462569257810.1002/jcsm.13331Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in ChinaMing‐jie Sheng0Jing‐yuan Cao1Shi‐mei Hou2Min Li3Yao Wang4Qiang Fang5A‐feng Miao6Min Yang7Shu‐su Liu8Chun‐hong Hu9Cui‐lan Liu10Shi‐yuan Wang11Jing Zheng12Jing‐jie Xiao13Xiao‐liang Zhang14Hong Liu15Bi‐cheng Liu16Bin Wang17Department of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology The First People's Hospital of Changzhou Changzhou ChinaDepartment of Nephrology The Affiliated Hospital of Yangzhou University, Yangzhou University Yangzhou ChinaDepartment of Nephrology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University Taizhou ChinaDepartment of Nephrology The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University Taizhou ChinaDepartment of Nephrology The First People's Hospital of Changzhou Changzhou ChinaDepartment of Nephrology The First People's Hospital of Changzhou Changzhou ChinaDepartment of Nephrology The Affiliated Hospital of Yangzhou University, Yangzhou University Yangzhou ChinaDepartment of Nephrology The Affiliated Hospital of Yangzhou University, Yangzhou University Yangzhou ChinaDepartment of Epidemiology and Health Statistics Southeast University School of Public Health Nanjing ChinaDepartment of Geriatrics, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaCovenant Health Palliative Institute Edmonton CanadaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaDepartment of Nephrology, Zhong Da Hospital Southeast University School of Medicine Nanjing ChinaAbstract Background Skeletal muscle mass and quality assessed by computed tomography (CT) images of the third lumbar vertebra (L3) level have been established as risk factors for poor clinical outcomes in several illnesses, but the relevance for dialysis patients is unclear. A few studies have suggested a correlation between CT‐determined skeletal muscle mass and quality at the first lumbar vertebra (L1) level and adverse outcomes. Generally, chest CT does not reach beyond L1. We aimed to determine whether opportunistic CT scan (chest CT)‐determined skeletal muscle mass and quality at L1 are associated with mortality in initial‐dialysis patients. Methods This 3‐year multicentric retrospective study included initial‐dialysis patients from four centres between 2014 and 2017 in China. Unenhanced CT images of the L1 and L3 levels were obtained to assess skeletal muscle mass [by skeletal muscle index, (SMI), cm2/m2] and quality [by skeletal muscle density (SMD), HU]. Skeletal muscle measures at L1 were compared with those at L3. The sex‐specific optimal cutoff values of L1 SMI and L1 SMD were determined in relation to all‐cause mortality. The outcomes were all‐cause death and cardiac death. Cox regression models were applied to investigate the risk factors for death. Results A total of 485 patients were enrolled, of whom 257 had both L1 and L3 images. Pearson's correlation coefficient between L1 and L3 SMI was 0.84 (P < 0.001), and that between L1 and L3 SMD was 0.90 (P < 0.001). No significant association between L1 SMI and mortality was observed (P > 0.05). Low L1 SMD (n = 280, 57.73%) was diagnosed based on the optimal cutoff value (<39.56 HU for males and <33.06 HU for females). Multivariate regression analysis revealed that the low L1 SMD group had higher risks of all‐cause death (hazard ratio 1.80; 95% confidence interval 1.05–3.11, P = 0.034) and cardiac death (hazard ratio 3.74; 95% confidence interval 1.43–9.79, P = 0.007). Conclusions In initial‐dialysis patients, there is high agreement between the L1 and L3 measures for SMI and SMD. Low SMD measured at L1, but not low SMI, is an independent predictor of both all‐cause death and cardiac death.https://doi.org/10.1002/jcsm.13331Computed tomographyDialysisFirst lumbar vertebra levelPrognosisSkeletal muscle quality |
| spellingShingle | Ming‐jie Sheng Jing‐yuan Cao Shi‐mei Hou Min Li Yao Wang Qiang Fang A‐feng Miao Min Yang Shu‐su Liu Chun‐hong Hu Cui‐lan Liu Shi‐yuan Wang Jing Zheng Jing‐jie Xiao Xiao‐liang Zhang Hong Liu Bi‐cheng Liu Bin Wang Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China Journal of Cachexia, Sarcopenia and Muscle Computed tomography Dialysis First lumbar vertebra level Prognosis Skeletal muscle quality |
| title | Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China |
| title_full | Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China |
| title_fullStr | Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China |
| title_full_unstemmed | Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China |
| title_short | Computed tomography‐determined skeletal muscle density predicts 3‐year mortality in initial‐dialysis patients in China |
| title_sort | computed tomography determined skeletal muscle density predicts 3 year mortality in initial dialysis patients in china |
| topic | Computed tomography Dialysis First lumbar vertebra level Prognosis Skeletal muscle quality |
| url | https://doi.org/10.1002/jcsm.13331 |
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