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Open Access 01-12-2023 | Computed Tomography | Research

Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers

Authors: Yu-Hao Wang, Yu-San Tee, Yu-Tung Wu, Chi-Tung Cheng, Chih-Yuan Fu, Chien-Hung Liao, Chi-Hsun Hsieh, Stewart C. Wang

Published in: BMC Geriatrics | Issue 1/2023

Abstract

Background

Perforated peptic ulcer (PPU) remains challenging surgically due to its high mortality, especially in older individuals. Computed tomography (CT)-measured skeletal muscle mass is a effective predictor of the surgical outcomes in older patients with abdominal emergencies. The purpose of this study is to assess whether a low CT-measured skeletal muscle mass can provide extra value in predicting PPU mortality.

Methods

This retrospective study enrolled older (aged ≥ 65 years) patients who underwent PPU surgery. Cross-sectional skeletal muscle areas and densities were measured by CT at L3 and patient-height adjusted to obtain the L3 skeletal muscle gauge (SMG). Thirty-day mortality was determined with univariate, multivariate and Kaplan–Meier analysis.

Results

From 2011 to 2016, 141 older patients were included; 54.8% had sarcopenia. They were further categorized into the PULP score ≤ 7 (n=64) or PULP score > 7 group (n=82). In the former, there was no significant difference in 30-day mortality between sarcopenic (2.9%) and nonsarcopenic patients (0%; p=1.000). However, in the PULP score > 7 group, sarcopenic patients had a significantly higher 30-day mortality (25.5% vs. 3.2%, p=0.009) and serious complication rate (37.3% vs. 12.9%, p=0.017) than nonsarcopenic patients. Multivariate analysis showed that sarcopenia was an independent risk factor for 30-day mortality in patients in the PULP score > 7 group (OR: 11.05, CI: 1.03-118.7).

Conclusion

CT scans can diagnose PPU and provide physiological measurements. Sarcopenia, defined as a low CT-measured SMG, provides extra value in predicting mortality in older PPU patients.

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Title: Sarcopenia provides extra value outside the PULP score for predicting mortality in older patients with perforated peptic ulcers
Authors: Yu-Hao Wang
Yu-San Tee
Yu-Tung Wu
Chi-Tung Cheng
Chih-Yuan Fu
Chien-Hung Liao
Chi-Hsun Hsieh
Stewart C. Wang
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Computed Tomography
Sarcopenia
Computed Tomography
Published in: BMC Geriatrics / Issue 1/2023
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-023-03946-7

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