Opportunistic Measurement of Skeletal Muscle Size and Muscle Attenuation on Computed Tomography Predicts 1-Year Mortality in Medicare Patients

Abstract

Background: Opportunistic assessment of sarcopenia on CT examinations is becoming increasingly common. This study aimed to determine relationships between CT-measured skeletal muscle size and attenuation with 1-year risk of mortality in older adults enrolled in a Medicare Shared Savings Program (MSSP).

Methods: Relationships between skeletal muscle metrics and all-cause mortality were determined in 436 participants (52% women, mean age 75 years) who had abdominopelvic CT examinations. On CT images, skeletal muscles were segmented at the level of L3 using two methods: (a) all muscles with a threshold of -29 to +150 Hounsfield units (HU), using a dedicated segmentation software, (b) left psoas muscle using a free-hand region of interest tool on a clinical workstation. Muscle cross-sectional area (CSA) and muscle attenuation were measured. Cox regression models were fit to determine the associations between muscle metrics and mortality, adjusting for age, sex, race, smoking status, cancer diagnosis, and Charlson comorbidity index.

Results: Within 1 year of follow-up, 20.6% (90/436) participants died. In the fully-adjusted model, higher muscle index and muscle attenuation were associated with lower risk of mortality. A one-unit standard deviation (SD) increase was associated with a HR = 0.69 (95% CI = 0.49, 0.96; p = .03) for total muscle index, HR = 0.67 (95% CI = 0.49, 0.90; p < .01) for psoas muscle index, HR = 0.54 (95% CI = 0.40, 0.74; p < .01) for total muscle attenuation, and HR = 0.79 (95% CI = 0.66, 0.95; p = .01) for psoas muscle attenuation.

Conclusion: In older adults, higher skeletal muscle index and muscle attenuation on abdominopelvic CT examinations were associated with better survival, after adjusting for multiple risk factors.

Keywords: Computed tomography; Electronic health records; Medical informatics; Myosteotosis; Sarcopenia.

Figure 1.

Kaplan–Meier plots for patients stratified by total muscle index. Patient survival is compared among three groups, ranging from at least 1 SD below cohort median (Z ≤ −1) to more than 1 SD above cohort median (Z > 1).

Figure 2.

Kaplan–Meier plots for patients stratified by psoas muscle index. Patient survival is compared among three groups, ranging from at least 1 SD below cohort median (Z ≤ −1) to more than 1 SD above cohort median (Z > 1).

Figure 3.

Kaplan–Meier plots for patients stratified by total muscle attenuation. Patient survival is compared among three groups, ranging from at least 1 SD below cohort median (Z ≤ −1) to more than 1 SD above cohort median (Z > 1).

Figure 4.

Kaplan–Meier plots for patients stratified by psoas muscle attenuation. Patient survival is compared among three groups, ranging from at least 1 SD below cohort median (Z ≤ −1) to more than 1 SD above cohort median (Z > 1).