Renal failure · 2025
Paraspinous muscle sarcopenic indices for predicting mortality in patients undergoing hemodialysis.
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Yajima Takahiro, Yajima Kumiko
Аннотация
BACKGROUND: We examined the association between computed tomography (CT)-derived paraspinous muscle density (PSMD) and index (PSMI) and all-cause mortality in patients undergoing hemodialysis.
METHODS: We included 234 hemodialysis patients and used CT images to measure PSMD and PSMI at the third lumbar vertebra level. PSMD and PSMI were determined as the average CT-based value of the paraspinous muscle in Hounsfield units (HUs) and as the paraspinous muscle area adjusted by height (cm2/m2), respectively. We used univariate and multivariate regression analysis to investigate the associations of PSMD and PSMI with baseline variables. Moreover, we used the Kaplan-Meier methods, Cox regression analysis, and prediction model discrimination to examine the relationships of these paraspinous sarcopenic indices with mortality risk.
RESULTS: The PSMD and PSMI were independently associated with the C-reactive protein level and geriatric nutritional risk index, respectively. The receiver operating curve-derived sex-specific cutoffs of PSMD and PSMI for predicting mortality were 32.1 HU and 13.29 cm2/m2 in women, and 38.4 HU and 14.97 cm2/m2 in men, respectively. Eighty-one patients died during a median follow-up period of 4.0 years. Lower PSMD alone was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR]: 3.14, 95% confidence interval [CI]: 1.81-5.46). In addition, only when PSMD was added to the baseline risk model, the net reclassification improvement significantly improved (0.516, p = 0.0001).
CONCLUSIONS: PSMD may be better than PSMI for predicting all-cause mortality risk in patients undergoing hemodialysis.
METHODS: We included 234 hemodialysis patients and used CT images to measure PSMD and PSMI at the third lumbar vertebra level. PSMD and PSMI were determined as the average CT-based value of the paraspinous muscle in Hounsfield units (HUs) and as the paraspinous muscle area adjusted by height (cm2/m2), respectively. We used univariate and multivariate regression analysis to investigate the associations of PSMD and PSMI with baseline variables. Moreover, we used the Kaplan-Meier methods, Cox regression analysis, and prediction model discrimination to examine the relationships of these paraspinous sarcopenic indices with mortality risk.
RESULTS: The PSMD and PSMI were independently associated with the C-reactive protein level and geriatric nutritional risk index, respectively. The receiver operating curve-derived sex-specific cutoffs of PSMD and PSMI for predicting mortality were 32.1 HU and 13.29 cm2/m2 in women, and 38.4 HU and 14.97 cm2/m2 in men, respectively. Eighty-one patients died during a median follow-up period of 4.0 years. Lower PSMD alone was independently associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR]: 3.14, 95% confidence interval [CI]: 1.81-5.46). In addition, only when PSMD was added to the baseline risk model, the net reclassification improvement significantly improved (0.516, p = 0.0001).
CONCLUSIONS: PSMD may be better than PSMI for predicting all-cause mortality risk in patients undergoing hemodialysis.