肌骨质疏松症作为接受普通手术的成年患者术后死亡率的预后指标--系统性综述

Surgeries Pub Date : 2023-11-29 DOI:10.3390/surgeries4040062
Onno Emanuel den Os, Rosalie Nielen, Elham Bidar
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引用次数: 0

摘要

背景:评估虚弱程度对于治疗手术患者以预测并发症或死亡率等围手术期和术后事件非常重要。目前的标准并不理想,因此正在评估新的预后指标,以丰富目前的虚弱评估。其中一个新指标是腰肌脂肪变性(肌骨质疏松症)。这可以通过计算机断层扫描(CT)测量腰肌密度(PMD)来评估。本综述旨在研究将腰肌密度以及肌骨质疏松症作为普外科成年患者术后死亡率的预后指标。研究方法在PubMed上进行电子检索,以确定PMD与术后死亡率相关的研究。本综述不考虑死亡率发生的时间段。本综述的研究结果衡量标准为危险比。结果:从 PubMed 上的 659 篇潜在文章中,纳入了 12 篇,共有 4834 名参与者。如果文章的重点不是 PMD,如果没有明确说明干预的类型,如果在第三节椎体水平上进行了 CT 以外的成像,则文章被排除在外。采用纽卡斯尔-渥太华量表(NOS)对纳入的文章进行了偏倚评估。经过多变量分析,当我们观察5年死亡率时,PMD被确定为几种心血管外科干预的独立重要预后标志物;当我们观察30天和3年死亡率时,PMD(除以腰肌面积(PMI))与术后死亡率之间存在轻微的显著保护性相关性。此外,当我们观察 30 天/90 天/1 年/3 年/5 年死亡率时,发现 PMD 是各种胃肠道外科干预的独立重要预后标志物。在泌尿外科手术中,PMD未被确定为重要的预后指标。结论:肌营养不良有可能成为目前对心血管、胃肠道或泌尿外科手术患者进行虚弱评估的重要依据。不过,还必须开展更多的研究来进一步加强肌骨软化症的预后价值,尤其要注意对结果进行性别或年龄等方面的解释。
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Myosteatosis as a Prognostic Marker for Postoperative Mortality in Adult Patients Undergoing Surgery in General—A Systematic Review
Background: Assessing frailty is important in treating surgical patients to predict peri- and postoperative events like complications or mortality. The current standard is not optimal; therefore, new prognostic markers are being evaluated to enrich the current frailty assessment. One of these new markers is fat degeneration of the psoas muscle (myosteatosis). This can be assessed by measuring the psoas muscle density (PMD) with computed tomography (CT). The aim of this review is to investigate PMD, and, thus, myosteatosis, as a prognostic marker for postoperative mortality in adult patients undergoing general surgery. Methods: An electronic search was performed in PubMed to identify relevant studies associating PMD with postoperative mortality. The looked-upon period for mortality to occur did not matter for this review. The looked-upon outcome measure for this review was the hazard ratio. Results: From 659 potential articles from PubMed, 12 were included, for a total of 4834 participants. Articles were excluded when not focused on PMD, if the type of intervention was not specified, and when imaging other than with CT on the level of the third vertebra was performed. The included articles were assessed for bias with the Newcastle–Ottawa Scale (NOS). PMD was, after multivariable analyses, identified as an independent significant prognostic marker for several surgical cardiovascular interventions when we looked at the 5-year mortality rate and for fenestrated branched endovascular aortic repair (F-BEVAR) a slight significant protective correlation between postoperative mortality and PMD (when divided by psoas muscle area (PMI)) when we looked at the 30-day and 3-year mortality. Also, PMD was identified as an independent significant prognostic marker for a variety of surgical gastrointestinal interventions when we looked at 30-day/90-day/1-year/3-year/5-year mortality. PMD was not identified as a significant prognostic marker in urologic surgery. Conclusion: Myosteatosis has the potential to be a valuable contribution to the current frailty assessment for patients undergoing cardiovascular, gastrointestinal, or urologic surgery. However, more research must be conducted to further strengthen the prognostic value of myosteatosis, with special attention to, e.g., gender- or age-specific interpretations of the results.
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