Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and...Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In female patients,the AUC for the CCR,SI,and RSMI were 0.615(95%CI=0.551-0.680),0.660(95%CI=0.598-0.722),and 0.772(95%CI=0.719-0.825),respectively.A multivariable logistic regression analysis demonstrated that the CCR remained an influential factor for sarcopenia after correcting for confounding[odds ratio(OR)=0.993,95%CI=0.986-1.000,P=0.038].The SI and RSMI also remained influential factors for sarcopenia after correcting for confounding factors(OR=0.983,95%CI=0.972-0.994,P=0.002;and OR=0.401,95%CI=0.320-0.502,P<0.001,respectively).The groups characterized by low CCR and SI demonstrated notably reduced overall survival compared with their counterparts with high CCR and SI(P=0.007 and P=0.001,respectively),whereas the RSMI and sarcopenia did not exhibit a significant correlation with survival(P=0.608 and P=0.062,respectively).Conclusions:The CCR,SI,and RSMI all have predictive value for sarcopenia in patients with CRC.TheRSMI was a better predictor of sarcopenia than either the CCR or SI in both male and female patientswith CRC.However,the RSMI did not have any significant value for predicting the prognosis of patients with CRC.Subsequent prospective investigations are warranted to elucidate a superiormarker or amalgamation thereof,capable of accurately prognosticating sarcopenia and the overall prognosis in individuals diagnosed with CRC.Such studies should aim to meticulously evaluate a comprehensive array of potential markers,considering their individual and collective predictive value in delineating the clinical trajectory of CRC patients.By conducting rigorous prospective analyses,researchers can strive to uncover novel insights into the complex interplay between sarcopenia and CRC outcomes,thereby facilitating the development of more precise prognostic models and tailored therapeutic approaches.展开更多
目的探讨骨骼肌质量指数(Skeletal muscle mass index,SMI)、肌少症指数(Sarcope-nia index,SI)与呼吸危重症患者营养状态及预后的关系。方法选取2021年9月至2023年8月南通市第一人民医院收治的呼吸危重患者132例。采用改良危重症营养...目的探讨骨骼肌质量指数(Skeletal muscle mass index,SMI)、肌少症指数(Sarcope-nia index,SI)与呼吸危重症患者营养状态及预后的关系。方法选取2021年9月至2023年8月南通市第一人民医院收治的呼吸危重患者132例。采用改良危重症营养风险评分表(The modi-fied nutrition risk in critically ill,mNUTRIC)评估患者营养状况,根据评分结果分为低风险患者(n=83)、高风险患者(n=49),比较低风险患者与高风险患者的SMI、SI。以离开ICU为时间终点评估预后,分为死亡组(n=37)和存活组(n=95),比较死亡组与存活组患者的一般资料,采用多因素Logistic回归模型分析影响呼吸危重症患者死亡的因素,受试者工作特征(Receiver operator characteristic,ROC)曲线分析SMI、SI预测呼吸危重症患者死亡的风险价值。结果与低风险患者相比,高风险患者的SMI、SI降低(P<0.05)。以离开重症监护室(Intensive care unit,ICU)为评估时间终点,与存活组相比,死亡组年龄、入院24 h内的急性生理评分、年龄评分及慢性健康评分(Acute physiology and chronic health evaluation scoring system,APACHEⅡ)评分及降钙素原(Procalcitonin,PCT)水平较高,白蛋白(Albumin,ALB)、SI和SMI则较低(P<0.05)。多因素Logistic回归模型显示,高APACHEⅡ评分及低SMI、SI值是影响呼吸危重症死亡的独立危险因素。ROC曲线显示,SMI、SI单独预测呼吸危重症患者死亡的曲线下面积(Area under curve,AUC)为0.784(0.720~0.839)、0.726(0.657~0.788),采用SMI、SI联合预测AUC为0.890(0.835~0.938),联合预测效能较单独预测效能更好(P<0.05)。结论SMI、SI与呼吸危重症患者营养状态关系密切,两者联合预测呼吸危重症患者死亡的临床价值高于单独预测。展开更多
基金supported by the Guangxi Medical and Health Appropriate Technology Development and Application Project(No.S2021095)Undergraduate Enrollment Project of Guangxi Medical University(No.S202410598186).
文摘Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In female patients,the AUC for the CCR,SI,and RSMI were 0.615(95%CI=0.551-0.680),0.660(95%CI=0.598-0.722),and 0.772(95%CI=0.719-0.825),respectively.A multivariable logistic regression analysis demonstrated that the CCR remained an influential factor for sarcopenia after correcting for confounding[odds ratio(OR)=0.993,95%CI=0.986-1.000,P=0.038].The SI and RSMI also remained influential factors for sarcopenia after correcting for confounding factors(OR=0.983,95%CI=0.972-0.994,P=0.002;and OR=0.401,95%CI=0.320-0.502,P<0.001,respectively).The groups characterized by low CCR and SI demonstrated notably reduced overall survival compared with their counterparts with high CCR and SI(P=0.007 and P=0.001,respectively),whereas the RSMI and sarcopenia did not exhibit a significant correlation with survival(P=0.608 and P=0.062,respectively).Conclusions:The CCR,SI,and RSMI all have predictive value for sarcopenia in patients with CRC.TheRSMI was a better predictor of sarcopenia than either the CCR or SI in both male and female patientswith CRC.However,the RSMI did not have any significant value for predicting the prognosis of patients with CRC.Subsequent prospective investigations are warranted to elucidate a superiormarker or amalgamation thereof,capable of accurately prognosticating sarcopenia and the overall prognosis in individuals diagnosed with CRC.Such studies should aim to meticulously evaluate a comprehensive array of potential markers,considering their individual and collective predictive value in delineating the clinical trajectory of CRC patients.By conducting rigorous prospective analyses,researchers can strive to uncover novel insights into the complex interplay between sarcopenia and CRC outcomes,thereby facilitating the development of more precise prognostic models and tailored therapeutic approaches.
文摘目的探讨骨骼肌质量指数(Skeletal muscle mass index,SMI)、肌少症指数(Sarcope-nia index,SI)与呼吸危重症患者营养状态及预后的关系。方法选取2021年9月至2023年8月南通市第一人民医院收治的呼吸危重患者132例。采用改良危重症营养风险评分表(The modi-fied nutrition risk in critically ill,mNUTRIC)评估患者营养状况,根据评分结果分为低风险患者(n=83)、高风险患者(n=49),比较低风险患者与高风险患者的SMI、SI。以离开ICU为时间终点评估预后,分为死亡组(n=37)和存活组(n=95),比较死亡组与存活组患者的一般资料,采用多因素Logistic回归模型分析影响呼吸危重症患者死亡的因素,受试者工作特征(Receiver operator characteristic,ROC)曲线分析SMI、SI预测呼吸危重症患者死亡的风险价值。结果与低风险患者相比,高风险患者的SMI、SI降低(P<0.05)。以离开重症监护室(Intensive care unit,ICU)为评估时间终点,与存活组相比,死亡组年龄、入院24 h内的急性生理评分、年龄评分及慢性健康评分(Acute physiology and chronic health evaluation scoring system,APACHEⅡ)评分及降钙素原(Procalcitonin,PCT)水平较高,白蛋白(Albumin,ALB)、SI和SMI则较低(P<0.05)。多因素Logistic回归模型显示,高APACHEⅡ评分及低SMI、SI值是影响呼吸危重症死亡的独立危险因素。ROC曲线显示,SMI、SI单独预测呼吸危重症患者死亡的曲线下面积(Area under curve,AUC)为0.784(0.720~0.839)、0.726(0.657~0.788),采用SMI、SI联合预测AUC为0.890(0.835~0.938),联合预测效能较单独预测效能更好(P<0.05)。结论SMI、SI与呼吸危重症患者营养状态关系密切,两者联合预测呼吸危重症患者死亡的临床价值高于单独预测。
