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

项目摘要/摘要： 炎症性肠病(IBD)是一种慢性疾病，由克罗恩病和溃疡性结肠炎组成 由免疫系统失调引起的。最初认为主要是年轻人的一种疾病， 改进的治疗、降低的死亡率和稳定的发病率改变了IBD的面貌。超过了 下个十年，患有炎症性肠病的老年人(≥60岁)预计将占三分之一以上 整个IBD患者群体。尽管如此，患有IBD的老年人经常被研究忽略， 限制可用于做出最佳临床决策的数据。这一点在一个领域尤为重要，即 术前计划。患有新发IBD的老年人5年手术率超过20%， 与年轻患者相比，术后死亡率高出一倍，三分之一的几率 经历了手术后的严重并发症。由于缺乏足够的术前风险 分层工具，临床医生经常开出长期无效和潜在有害的治疗方法。 希望避免手术，进一步增加这种手术风险。因此，适当的术前风险分层 要改善对患有IBD的老年人的护理，工具势在必行。骨质疏松症就是这样一种风险分层。 这一工具与腹部手术患者的术后结果有关。 然而，目前还没有研究评估老年IBD患者的这一点，也没有标准化的方法来评估 根据常规的术前影像评估IBD的肌肉质量和密度。因此，这一目标是 建议确定对术后最具预测性的肌肉横断面测量。 老年IBD患者的并发症，并建立一个术前风险分层工具，结合 对已知IBD和手术危险因素的肌肉进行横断面成像评估。一次回顾 将对所有接受过炎症性肠病相关手术的60岁≥患者进行回顾， 术前测量总腰大肌指数、骨骼肌指数和Hounsfield单位平均计算 在成像方面。我们的主要结果将是术后30天的死亡率和主要 并发症。一种结合最优横断面测量的多变量模型 已知的手术风险因素将被用来预测老年人术后并发症的风险 成人IBD。这将是第一项评估患有IBD的老年人石棺减少的研究，并将作为 为这一群体中未来的风险分层模型奠定基础。作为我职业发展的一部分，这 奖励将产生初步数据，可用于为未来的验证研究提供信息，包括 其他衡量骨质疏松症的指标，如握力。此外，在我的指导下， 团队，我将同时发展衰老研究的新技能，以便在后续研究中发扬光大 在老年学和IBD的交汇点。

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.