Sarcopenia is a Novel Predictor of the Need for Rescue Therapy in Hospitalized Ulcerative Colitis Patients
Sarcopenia is a Novel Predictor of the Need for Rescue Therapy in Hospitalized Ulcerative Colitis Patients
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DOI：
10.1093/ecco-jcc/jjy064
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发表时间：
2018-09-01
影响因子：
8
通讯作者：
Ananthakrishnan, Ashwin N.
中科院分区：
文献类型：
--
作者：
Cushing, Kelly C.;Kordbacheh, Hamed;Ananthakrishnan, Ashwin N.
背景和目的：四分之一的 UC 患者患有急性重症溃疡性结肠炎 [ASUC]。临床参数在预测救援治疗的需要方面表现不佳。肌肉减少症和内脏肥胖可预测克罗恩病的自然病程，但此类代谢因素对 ASUC 结果的作用尚不清楚。本研究的目的是明确肌肉减少症和内脏肥胖对 ASUC 结局的影响。方法：我们研究了因 ASUC 住院的患者，他们在住院期间接受了腹部 CT 扫描。骨骼肌质量和内脏脂肪的量化是由对结果不知情的放射科医生进行的。少肌症定义为男性骨骼肌指数< 55 cm(2)/m(2)，女性骨骼肌指数< 39 cm(2)/m(2)。主要关注的结局是是否需要药物或手术抢救治疗。结果：我们的研究纳入了 89 名 ASUC 患者，其中 39 例 [43.8%] 患者需要药物抢救治疗或手术。该队列中三分之二的人 [70%] 符合肌少症的定义 [81% 男性，48% 女性]。肌肉减少症患者与肌肉质量正常的患者具有相似的疾病特征和实验室参数。然而，与没有肌少症的患者相比，需要抢救治疗的肌少症患者比例更大（56% vs 28%，多变量比值比 [OR] 3.98，95% 置信区间 [CI] 1.12-14.1）。内脏脂肪 [p = 0.23] 和皮下脂肪 [p = 0.53] 均不能预测是否需要抢救治疗。结论：腹部 CT 确定的肌少症是住院 UC 患者需要抢救治疗的新预测因素。
Background and Aims: Acute severe ulcerative colitis [ASUC] affects one in four patients with UC. Clinical parameters perform modestly in predicting the need for rescue therapy. Sarcopenia and visceral adiposity predict natural history in Crohn's disease, but the role of such metabolic factors on ASUC outcomes is unknown. The aim of this study was to define the effect of sarcopenia and visceral adiposity on outcomes in ASUC.Methods: We studied patients hospitalized for ASUC who underwent an abdominal CT scan during the hospitalization. Quantification of skeletal muscle mass and visceral adiposity was performed by radiologists blinded to the outcome. Sarcopenia was defined as a skeletal muscle index of < 55 cm(2)/m(2) for men and < 39 cm(2)/m(2) for women. The primary outcome of interest was need for medical or surgical rescue therapy.Results: Our study included 89 patients with ASUC, among whom 39 [43.8%] patients required medical rescue therapy or surgery. Two-thirds of the cohort [70%] met the definition of sarcopenia [81% men, 48% women]. Patients with sarcopenia had similar disease characteristics and laboratory parameters to those with a normal muscle mass. However, a larger proportion of patients with sarcopenia required rescue therapy compared with those without (56% vs 28%, multivariable odds ratio [OR] 3.98, 95% confidence interval [CI] 1.12-14.1). Neither visceral [p = 0.23] nor subcutaneous adiposity [p = 0.53] predicted the need for rescue therapy.Conclusions: Sarcopenia as determined on abdominal CT was a novel predictor of need for rescue therapy in hospitalized UC patients.