Association of CT-based diagnosis of sarcopenia with prognosis and treatment response in patients at risk of malnutrition - A secondary analysis of the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial

Annic Baumgartner; Tobias Olpe; Stephanie Griot; Nicole Mentil; Nathalie Staub; Felice Burn; Sebastian Schindera; Nina Kaegi-Braun; Pascal Tribolet; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Brändle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.clnu.2022.12.006

Association of CT-based diagnosis of sarcopenia with prognosis and treatment response in patients at risk of malnutrition - A secondary analysis of the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial

Clin Nutr. 2023 Feb;42(2):199-207. doi: 10.1016/j.clnu.2022.12.006. Epub 2022 Dec 22.

Authors

Annic Baumgartner¹, Tobias Olpe², Stephanie Griot², Nicole Mentil², Nathalie Staub², Felice Burn³, Sebastian Schindera³, Nina Kaegi-Braun¹, Pascal Tribolet⁴, Claus Hoess⁵, Vojtech Pavlicek⁵, Stefan Bilz⁶, Sarah Sigrist⁶, Michael Brändle⁶, Christoph Henzen⁷, Robert Thomann⁸, Jonas Rutishauser⁹, Drahomir Aujesky¹⁰, Nicolas Rodondi¹¹, Jacques Donzé¹², Zeno Stanga¹³, Beat Mueller¹⁴, Philipp Schuetz¹⁵

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
² Medical Faculty of the University of Basel, Switzerland.
³ Department of Radiology Kantonsspital Aarau, Aarau, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁵ Internal Medicine, Kantonsspital Muensterlingen, Switzerland.
⁶ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland.
⁷ Internal Medicine, Kantonsspital Luzern, Switzerland.
⁸ Internal Medicine, Buergerspital Solothurn, Switzerland.
⁹ Internal Medicine, Kantonsspital Baden, Switzerland.
¹⁰ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹¹ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹³ Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
¹⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. Electronic address: philipp.schuetz@ksa.ch.

PMID: 36603460
DOI: 10.1016/j.clnu.2022.12.006

Abstract

Background & aim: CT-derived measures of muscle mass may help to identify patients with sarcopenia. We investigated the prognostic significance of CT-derived sarcopenia and muscle attenuation with nutritional markers, clinical outcomes and response to nutritional support in medical in-patients at nutritional risk.

Method: Within this secondary analysis of the randomized-controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) comparing individualized nutritional support with usual care nutrition in medical inpatients, we investigated associations of CT-based sarcopenia and muscle attenuation at the level L3 with different nutritional and clinical outcomes, and the response to the nutritional intervention. The primary composite endpoint was adverse clinical outcome within 30 days of hospital admission.

Results: We included 573 of 2028 EFFORT patients with available CT scans, of which 68.4% met the CT-based definition of sarcopenia and 72.9% had low muscle attenuation. In multivariate analysis, low skeletal muscle index was associated with higher nutritional risk (coefficient per NRS class -0.94 (95%CI -1.87 to -0.01) p = 0.049) and higher risk for adverse clinical outcomes (adjusted odds ratio 1.59 (95% CI 1.06 to 2.38), p = 0.024). Low muscle attenuation was also associated with adverse clinical outcome (adjusted odds ratio 1.67 (95%CI 1.08 to 2.58), p = 0.02). Nutritional support tended to be more effective in reducing mortality in non-sarcopenic patients compared to patients with CT-based sarcopenia (p for interaction 0.058).

Conclusions: Within a population of medical patients at nutritional risk, CT-based sarcopenia and muscle attenuation were associated with several nutritional parameters and predicted adverse clinical outcomes. Information from CT scans, thus may help to better characterize these patients, and may be helpful in guiding therapeutic interventions.

Trial registration: ClinicalTrials.gov NCT02517476.

Keywords: CT; Clinical outcomes; Malnutrition; Nutritional risk score 2002; Sarcopenia; Skeletal muscle index.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Frailty* / complications
Humans
Inpatients
Malnutrition* / complications
Malnutrition* / diagnosis
Malnutrition* / therapy
Nutritional Support
Prognosis
Sarcopenia* / complications
Sarcopenia* / diagnostic imaging
Sarcopenia* / therapy
Tomography, X-Ray Computed

Associated data

ClinicalTrials.gov/NCT02517476