Sarcopenia as a Preoperative Risk Stratification Tool Among Older Adults with Inflammatory Bowel Disease

肌肉减少症作为老年炎症性肠病患者的术前风险分层工具

• 批准号: 10518524
• 负责人: Adam Scotte Faye
• 金额: $ 16.95万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10518524
• 关键词: Abdomen; Adrenal Cortex Hormones; Adult; Adverse event; Age; Age-Years; Aging; American; Area; Cardiac; Caring; Characteristics; Chronic Disease; Chronology; Clinical; Colon and Rectal Surgeon; Complication; Critical Care; Crohn' s disease; Data; Development; Disease; Dose; Elderly; Event; Exclusion Criteria; Foundations; Future; Gastroenterology; Geriatrics; Gerontology; Goals; Growth; Hand Strength; Health; Hemorrhage; High Prevalence; Image; Immune system; Incidence; Individual; Infection; Inflammatory Bowel Diseases; Intervention; K-Series Research Career Programs; Kidney Failure; Lead; Malignant neoplasm of gastrointestinal tract; Measures; Mentorship; Methodology; Modeling; Muscle; Muscular Atrophy; Newly Diagnosed; Operative Surgical Procedures; Outcome; Outcomes Research; Patients; Persons; Population; Postoperative Complications; Postoperative Period; Predictive Value; Radiology Specialty; Repeat Surgery; Research; Risk; Risk Assessment; Risk Factors; Skeletal Muscle; Societies; Standardization; Stroke; Structure; Time; Training; Ulcerative Colitis; Work; base; chronic liver disease; density; disorder risk; evidence base; experience; high risk; hospital readmission; improved; indexing; mortality; muscle form; muscle strength; older patient; patient population; patient subsets; primary outcome; programs; prospective; research study; risk stratification; sarcopenia; skills; surgery outcome; surgical risk; tool; validation studies; venous thromboembolism

Project Summary/Abstract: Inflammatory bowel disease (IBD), comprised of Crohn’s disease and ulcerative colitis, is a chronic disorder caused by dysregulation of the immune system. Initially thought to predominantly be a disease of the young, improved treatments, decreasing mortality, and steady incidence have shifted the landscape of IBD. Over the next decade, older adults (≥60 years of age) with IBD are expected to comprise more than one-third of the entire IBD patient population. Despite this, older adults with IBD are often omitted from research studies, limiting the data available to make optimal clinical decisions. One area this is particularly important in, is preoperative planning. Older adults with new onset IBD have over a 20% 5-year incidence of surgery, four times higher odds of postoperative mortality as compared to younger patients, and a one-third chance of experiencing a major complication as a result of surgery. Due to the lack of adequate preoperative risk stratification tools, clinicians often prescribe prolonged periods of ineffective and potentially harmful therapies in hopes of avoiding surgery, further increasing this surgical risk. Thus, adequate preoperative risk stratification tools are imperative to improving the care of older adults with IBD. Sarcopenia is one such risk stratification tool that has been associated with postoperative outcomes in patients undergoing abdominal surgery. Currently, however, there are no studies assessing this in older patients with IBD, and no standardized way to assess muscle mass and density based on routine preoperative imaging in IBD. Therefore, the goal of this proposal is to determine the cross-sectional measure of muscle that is most predictive of postoperative complications among older adults with IBD, and to build a preoperative risk stratification tool that combines cross-sectional imaging assessments of muscle with known IBD and surgical risk factors. A retrospective review of all patients with IBD ≥ 60 years of age who have undergone IBD-related surgery will be performed, measuring preoperative Total Psoas Index, Skeletal Muscle Index, and Hounsfield Unit Average Calculations on imaging. Our primary outcome will be a 30-day composite of postoperative mortality and major complications. A multivariable model combining the optimal cross-sectional measure of muscle mass along with known surgical risk factors will then be used to predict the risk of postoperative complications among older adults with IBD. This will be the first study to assess sarcopenia in older adults with IBD, and will serve as the foundation for future risk stratification models in this subpopulation. As part of my career development, this award will generate preliminary data that can be used to inform prospective validation studies, incorporating additional measures of sarcopenia such as grip strength. Additionally, under the guidance of my mentorship team, I will simultaneously develop new skills in aging research that I can carry forward in subsequent studies at the intersection of gerontology and IBD.

项目概要/摘要： 炎症性肠病（IBD）是一种慢性疾病，包括克罗恩病和溃疡性结肠炎 是由免疫系统失调引起的最初认为主要是一种年轻人的疾病， 治疗方法的改进、死亡率的降低和稳定的发病率改变了IBD的面貌。来 下一个十年，预计IBD老年人（≥60岁）将占全球IBD患者的三分之一以上。 所有IBD患者。尽管如此，患有IBD的老年人经常被排除在研究之外， 限制了可用于做出最佳临床决策的数据。其中一个特别重要的领域是， 术前计划新发IBD的老年人5年手术发生率超过20%， 与年轻患者相比，术后死亡率高出一倍， 手术后出现严重并发症由于术前风险不足 分层工具，临床医生往往规定长期无效和潜在有害的治疗 希望避免手术，进一步增加手术风险。因此，充分的术前风险分层 这些工具对于改善IBD老年人的护理至关重要。肌肉减少症就是这样一种危险分层 该工具与接受腹部手术的患者的术后结局相关。 然而，目前还没有研究在老年IBD患者中评估这一点，也没有标准化的方法来 根据IBD患者的常规术前成像评估肌肉质量和密度。因此，这一目标 建议是确定最能预测术后肌肉的横截面测量值， 老年IBD患者的并发症，并建立术前风险分层工具， 对具有已知IBD和手术风险因素的肌肉进行横断面成像评估。回顾性 将对所有接受IBD相关手术的≥ 60岁IBD患者进行审查， 测量术前总腰大肌指数、骨骼肌指数和Hounsfield单位平均值计算 在成像上。我们的主要结局将是30天的术后死亡率和主要 并发症结合肌肉质量最佳横截面测量的多变量模型沿着 与已知的手术风险因素，然后将用于预测老年人术后并发症的风险， 成人IBD这将是第一项评估IBD老年人肌肉减少症的研究，并将作为 为该亚群未来的风险分层模型奠定基础。作为我职业发展的一部分， 该奖项将产生初步数据，可用于通知前瞻性验证研究，包括 肌肉减少症的额外测量，例如握力。此外，在我的指导下， 团队，我将同时发展新的技能，在老龄化研究，我可以发扬在随后的研究 老年学和IBD的交叉点