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Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

ABSTRACT: The purpose of this study was to evaluate the prevalence of sarcopenia and/or myosteatosis in elderly patients with pelvic ring injuries and their influence on mortality, patient-perceived physical functioning and quality of life (QoL). A multicenter retrospective cohort study was conducted including elderly patients aged ≥ 65 treated for a pelvic ring injury. Cross-sectional computed tomography (CT) muscle measurements were obtained to determine the presence of sarcopenia and/or myosteatosis. Kaplan-Meier analysis was used for survival analysis, and Cox proportional hazards regression analysis was used to determine risk factors for mortality. Patient-reported outcome measures for physical functioning (SMFA) and QoL (EQ-5D) were used. Multivariable linear regression analyses were used to determine the effect of sarcopenia and myosteatosis on patient-perceived physical functioning and QoL. Data to determine sarcopenia and myosteatosis were available for 199 patients, with a mean follow-up of 2.4 ± 2.2 years: 66 patients (33%) were diagnosed with sarcopenia and 65 (32%) with myosteatosis, while 30 of them (15%) had both. Mortality rates in patients at 1 and 3 years without sarcopenia and myosteatosis were 13% and 21%, compared to 11% and 36% in patients with sarcopenia, 17% and 31% in patients with myosteatosis and 27% and 43% in patients with both. Higher age at the time of injury and a higher Charlson Comorbidity Index (CCI) were independent risk factors for mortality. Patient-reported mental and emotional problems were significantly increased in patients with sarcopenia.

SUBMITTER: Banierink H

PROVIDER: S-EPMC8584633 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

Banierink Hester H Bombach Julia J C JJC Ten Duis Kaj K IJpma Frank F A FFA Heineman Erik E van Helden Sven H SH Nijveldt Robert J RJ Viddeleer Alain R AR Reininga Inge H F IHF

Journal of clinical medicine 20211022 21

The purpose of this study was to evaluate the prevalence of sarcopenia and/or myosteatosis in elderly patients with pelvic ring injuries and their influence on mortality, patient-perceived physical functioning and quality of life (QoL). A multicenter retrospective cohort study was conducted including elderly patients aged ≥ 65 treated for a pelvic ring injury. Cross-sectional computed tomography (CT) muscle measurements were obtained to determine the presence of sarcopenia and/or myosteatosis. K ...[more]

PMID: 34768394

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Project description:BackgroundPelvic ring injuries in the elderly often occur after low-energy accidents. They may result in prolonged immobilization, complications and an intense rehabilitation process. The aim of this study was to assess mortality, physical functioning and quality of life (QoL) in elderly patients with pelvic ring injuries.MethodsA cross-sectional study was performed including all elderly patients (≥ 65 years) admitted for a pelvic ring injury between 2007-2016. Mortality and survival were evaluated and patient reported outcome measures (PROMs) were used to assess physical functioning (SMFA) and QoL (EQ-5D). These were compared to age-matched normative data from the general Dutch population.ResultsA total of 153 patients, with a mean age of 79 years (SD 8) at the time of injury, were included in this study. The mortality rate was 20% at 30 days, 27% at 1 year and 41% at 3 years of follow-up. All six patients with a type C fracture died within 30 days. Analyses of the 153 patients showed that increasing age, fracture type C and Injury Severity Score (ISS) were all independent risk factors for mortality. Eventually, after excluding patients that died (N = 78) or were unable to contact (N = 2), 73 patients were eligible for follow-up, of which 53 patients (73%) responded. Mean Short Musculoskeletal Function Assessment (SMFA) scores were respectively 67.4 (function index), 65.2 (bother index), 66.5 (lower extremity), 60.4 (activities of daily living) and 68.2 (emotion). Mean EuroQuol-5D (EQ-5D) score was 0.72. Overall, physical functioning and quality of life were significantly decreased in comparison with normative data from the general population.ConclusionElderly people who sustain a pelvic ring injury should be considered as a fragile population with substantial mortality rates. The patients who survived demonstrated a substantially lower level of physical functioning and quality of life in comparison with their age-matched peers from the general population.Level of evidenceIV, therapeutic study.

Project description:BackgroundPelvic ring injuries are one of the most serious traumatic injuries with large consequences for the patients' daily life. During recent years, the importance of the patients' perception of their functioning and quality of life following injury has increasingly received attention. This systematic review reports on self-reported physical functioning and quality of life after all types of pelvic ring injuries.MethodsThe online databases MEDLINE-PubMed and Ovid-EMBASE were searched for studies published between 2008 and 2019 to identify published evidence of patient-reported physical functioning and quality of life after which they were assessed for their methodological quality.ResultsOf the 2577 articles, 46 were reviewed in full-text, including 3049 patients. Most studies were heterogeneous, with small cohorts of patients, a variety of injury types, treatment methods and use of different, often non-validated, outcome measures. The overall methodological quality was moderate to poor. Nine different PROMs were used, of which the Majeed Pelvic Score (MPS), SF-36 and EQ-5D were the most widely used. Mean scores respectively ranged from 75-95 (MPS), 53-69 (SF-36, physical functioning) and 0.63-0.80 (EQ-5D).ConclusionsPhysical functioning and quality of life following pelvic ring injuries seem fair and tend to improve during follow-up. However, differences in patient numbers, injury definition, treatment strategy, follow-up duration and type of PROMs used between studies hampers to elucidate the actual effects of pelvic ring injuries on a patient's life.Implications of key findingsPhysicians and researchers should use valid and reliable patient-reported outcome instruments on large cohorts of patients with properly defined injuries to truly evaluate physical functioning and quality of life after pelvic ring injuries.Systematic review registration numberPROSPERO International prospective register of systematic reviews; registration number CRD42019129176.

Project description:Background and purposeSarcopenia is highly prevalent (28.5-40.3%) in patients undergoing hemodialysis and leads to poor clinical outcomes. However, the association between muscle quality and sarcopenia in patients receiving hemodialysis remains unclear. Therefore, we aimed to explore the association between muscle cross-sectional area (CSA) and proton-density fat-fraction (PDFF) in patients with sarcopenia undergoing hemodialysis.MethodsSeventy-six patients undergoing hemodialysis for > 3 months were enrolled. Their handgrip strength (HGS), short physical performance battery (SPPB) performance, and appendicular skeletal muscle mass index (ASMI) were measured. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus update. All patients underwent quantitative magnetic resonance imaging. CSA and PDFF were measured for the thigh, trunk, and gluteus muscles.ResultsThe prevalence of probable, confirmed, and severe sarcopenia in this study was 73.7%, 51.3%, and 22.4%, respectively. Older age (OR: 1.061, P < 0.003); lower body mass index (BMI) (OR: 0.837, P = 0.008), albumin (OR: 0.765, P = 0.004), prealbumin (OR: 0.987, P = 0.001), predialysis blood urea nitrogen (BUN) (OR: 0.842, P < 0.001), predialysis creatinine (OR: 0.993, P < 0.001), phosphorus (OR: 0.396, P = 0.047); lower CSA of the thigh (OR: 0.58, P = 0.035), third lumbar (L3) trunk (OR: 0.37, P = 0.004), gluteus minimus and medius (OR: 0.28, P = 0.001), and gluteus maximus (OR: 0.28, P= 0.001); and higher PDFF of the thigh (OR: 1.89, P = 0.036) and L3 trunk (OR: 1.71, P = 0.040) were identified as sarcopenia risk factors. The gluteus minimus and medius CSA was lower in patients with sarcopenia than in those without after adjusting for age and BMI (OR: 0.37, P = 0.017). Higher thigh (P = 0.031) and L3 trunk (P = 0.006) muscle PDFF were significantly associated with lower HGS. Furthermore, higher thigh (P = 0.011) and L3 trunk (P = 0.010) muscle PDFF were also inversely correlated with lower ASMI.ConclusionOur findings demonstrate the high prevalence of sarcopenia and myosteatosis in patients undergoing hemodialysis and might trigger a paradigm shift in intervention strategies for patients receiving hemodialysis.

Project description:Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon's preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state-timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

Dataset Information

Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

Publications

Are Sarcopenia and Myosteatosis in Elderly Patients with Pelvic Ring Injury Related to Mortality, Physical Functioning and Quality of Life?

Similar Datasets

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