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. 2017 Jun 23;12(6):e0180036.
doi: 10.1371/journal.pone.0180036. eCollection 2017.

Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease

Shigeki Bamba  1 , Masaya Sasaki  2 , Azusa Takaoka  2 , Kenichiro Takahashi  1 , Hirotsugu Imaeda  1 , Atsushi Nishida  1 , Osamu Inatomi  1 , Mitsushige Sugimoto  1 , Akira Andoh  1
Affiliations

Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease

Shigeki Bamba et al. PLoS One. .

Abstract

The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD) remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera's prognostic nutritional index (O-PNI) and the controlling nutritional status (CONUT) index. The L3 skeletal muscle index (SMI), which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3) vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn's disease (CD) and 48% with ulcerative colitis (UC)). In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015) and disease type (CD or UC) (P = 0.007) were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003) and a stratified analysis of CD patients (P = 0.001) using the Kaplan-Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Dispersion graphs depicting correlations between SMI and sex (a), age (b), BMI (c), BW (d), height (e), hematocrit (f), albumin (g), CRP (h), O-PNI (i), CONUT (j), SGA (k), MUST (l), NRS-2002 (m), REE (n), and REE/BW (o). P values on each graph were calculated for all IBD patients. Rho indicates Spearman’s rank correlation coefficient. *Logistic regression analysis. OR: odds ratio, SMI: skeletal muscle index, BMI: body mass index, BW: body weight, CRP: C-reactive protein, O-PNI: Onodera’s prognostic nutritional index, CONUT: controlling nutritional status, SGA: subjective global assessment, MUST: malnutritional universal screening tool, NRS-2002: nutritional risk screening-2002, REE: resting energy expenditure.
Fig 2
Fig 2
Cumulative operation-free survival rate for all patients (a), patients with Crohn’s disease (b), patients with ulcerative colitis (c).
Fig 3
Fig 3. Changes of SMI after intestinal resection.
Solid and dashed line indicates patients with CD and UC, respectively. Double vertical lines indicate intestinal resection. AZA: azathioprine.
See this image and copyright information in PMC

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