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Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers

BACKGROUND: Perforated peptic ulcer (PPU) remains challenging surgically due to its high mortality, especially in older individuals. Computed tomography (CT)-measured skeletal muscle mass is a effective predictor of the surgical outcomes in older patients with abdominal emergencies. The purpose of t...

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Autores principales: Wang, Yu-Hao, Tee, Yu-San, Wu, Yu-Tung, Cheng, Chi-Tung, Fu, Chih-Yuan, Liao, Chien-Hung, Hsieh, Chi-Hsun, Wang, Stewart C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161495/
https://www.ncbi.nlm.nih.gov/pubmed/37142974
http://dx.doi.org/10.1186/s12877-023-03946-7
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author Wang, Yu-Hao
Tee, Yu-San
Wu, Yu-Tung
Cheng, Chi-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Hsieh, Chi-Hsun
Wang, Stewart C.
author_facet Wang, Yu-Hao
Tee, Yu-San
Wu, Yu-Tung
Cheng, Chi-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Hsieh, Chi-Hsun
Wang, Stewart C.
author_sort Wang, Yu-Hao
collection PubMed
description BACKGROUND: Perforated peptic ulcer (PPU) remains challenging surgically due to its high mortality, especially in older individuals. Computed tomography (CT)-measured skeletal muscle mass is a effective predictor of the surgical outcomes in older patients with abdominal emergencies. The purpose of this study is to assess whether a low CT-measured skeletal muscle mass can provide extra value in predicting PPU mortality. METHODS: This retrospective study enrolled older (aged ≥ 65 years) patients who underwent PPU surgery. Cross-sectional skeletal muscle areas and densities were measured by CT at L3 and patient-height adjusted to obtain the L3 skeletal muscle gauge (SMG). Thirty-day mortality was determined with univariate, multivariate and Kaplan–Meier analysis. RESULTS: From 2011 to 2016, 141 older patients were included; 54.8% had sarcopenia. They were further categorized into the PULP score ≤ 7 (n=64) or PULP score > 7 group (n=82). In the former, there was no significant difference in 30-day mortality between sarcopenic (2.9%) and nonsarcopenic patients (0%; p=1.000). However, in the PULP score > 7 group, sarcopenic patients had a significantly higher 30-day mortality (25.5% vs. 3.2%, p=0.009) and serious complication rate (37.3% vs. 12.9%, p=0.017) than nonsarcopenic patients. Multivariate analysis showed that sarcopenia was an independent risk factor for 30-day mortality in patients in the PULP score > 7 group (OR: 11.05, CI: 1.03-118.7). CONCLUSION: CT scans can diagnose PPU and provide physiological measurements. Sarcopenia, defined as a low CT-measured SMG, provides extra value in predicting mortality in older PPU patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03946-7.
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spelling pubmed-101614952023-05-06 Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers Wang, Yu-Hao Tee, Yu-San Wu, Yu-Tung Cheng, Chi-Tung Fu, Chih-Yuan Liao, Chien-Hung Hsieh, Chi-Hsun Wang, Stewart C. BMC Geriatr Research BACKGROUND: Perforated peptic ulcer (PPU) remains challenging surgically due to its high mortality, especially in older individuals. Computed tomography (CT)-measured skeletal muscle mass is a effective predictor of the surgical outcomes in older patients with abdominal emergencies. The purpose of this study is to assess whether a low CT-measured skeletal muscle mass can provide extra value in predicting PPU mortality. METHODS: This retrospective study enrolled older (aged ≥ 65 years) patients who underwent PPU surgery. Cross-sectional skeletal muscle areas and densities were measured by CT at L3 and patient-height adjusted to obtain the L3 skeletal muscle gauge (SMG). Thirty-day mortality was determined with univariate, multivariate and Kaplan–Meier analysis. RESULTS: From 2011 to 2016, 141 older patients were included; 54.8% had sarcopenia. They were further categorized into the PULP score ≤ 7 (n=64) or PULP score > 7 group (n=82). In the former, there was no significant difference in 30-day mortality between sarcopenic (2.9%) and nonsarcopenic patients (0%; p=1.000). However, in the PULP score > 7 group, sarcopenic patients had a significantly higher 30-day mortality (25.5% vs. 3.2%, p=0.009) and serious complication rate (37.3% vs. 12.9%, p=0.017) than nonsarcopenic patients. Multivariate analysis showed that sarcopenia was an independent risk factor for 30-day mortality in patients in the PULP score > 7 group (OR: 11.05, CI: 1.03-118.7). CONCLUSION: CT scans can diagnose PPU and provide physiological measurements. Sarcopenia, defined as a low CT-measured SMG, provides extra value in predicting mortality in older PPU patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-023-03946-7. BioMed Central 2023-05-04 /pmc/articles/PMC10161495/ /pubmed/37142974 http://dx.doi.org/10.1186/s12877-023-03946-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Wang, Yu-Hao
Tee, Yu-San
Wu, Yu-Tung
Cheng, Chi-Tung
Fu, Chih-Yuan
Liao, Chien-Hung
Hsieh, Chi-Hsun
Wang, Stewart C.
Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title_full Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title_fullStr Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title_full_unstemmed Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title_short Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
title_sort sarcopenia provides extra value outside the pulp score for predicting mortality in older patients with perforated peptic ulcers
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161495/
https://www.ncbi.nlm.nih.gov/pubmed/37142974
http://dx.doi.org/10.1186/s12877-023-03946-7
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