Sarcopenia as a Preoperative Risk Stratification Tool Among Older Adults with Inflammatory Bowel Disease

肌肉减少症作为老年炎症性肠病患者的术前风险分层工具

基本信息

批准号：
10518524
负责人：
Adam Scotte Faye
金额：
$ 16.95万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10518524
关键词：
Abdomen Adrenal Cortex Hormones Adult Adverse event Age Age-Years Aging American Area Cardiac Caring Characteristics Chronic Disease Chronology Clinical Colon and Rectal Surgeon Complication Critical Care Crohn&apos s disease Data Development Disease Dose Elderly Event Exclusion Criteria Foundations Future Gastroenterology Geriatrics Gerontology Goals Growth Hand Strength Health Hemorrhage High Prevalence Image Immune system Incidence Individual Infection Inflammatory Bowel Diseases Intervention K-Series Research Career Programs Kidney Failure Lead Malignant neoplasm of gastrointestinal tract Measures Mentorship Methodology Modeling Muscle Muscular Atrophy Newly Diagnosed Operative Surgical Procedures Outcome Outcomes Research Patients Persons Population Postoperative Complications Postoperative Period Predictive Value Radiology Specialty Repeat Surgery Research Risk Risk Assessment Risk Factors Skeletal Muscle Societies Standardization Stroke Structure Time Training Ulcerative Colitis Work base chronic liver disease density disorder risk evidence base experience high risk hospital readmission improved indexing mortality muscle form muscle strength older patient patient population patient subsets primary outcome programs prospective research study risk stratification sarcopenia skills surgery outcome surgical risk tool validation studies venous thromboembolism

项目摘要

Project Summary/Abstract: Inflammatory bowel disease (IBD), comprised of Crohn’s disease and ulcerative colitis, is a chronic disorder caused by dysregulation of the immune system. Initially thought to predominantly be a disease of the young, improved treatments, decreasing mortality, and steady incidence have shifted the landscape of IBD. Over the next decade, older adults (≥60 years of age) with IBD are expected to comprise more than one-third of the entire IBD patient population. Despite this, older adults with IBD are often omitted from research studies, limiting the data available to make optimal clinical decisions. One area this is particularly important in, is preoperative planning. Older adults with new onset IBD have over a 20% 5-year incidence of surgery, four times higher odds of postoperative mortality as compared to younger patients, and a one-third chance of experiencing a major complication as a result of surgery. Due to the lack of adequate preoperative risk stratification tools, clinicians often prescribe prolonged periods of ineffective and potentially harmful therapies in hopes of avoiding surgery, further increasing this surgical risk. Thus, adequate preoperative risk stratification tools are imperative to improving the care of older adults with IBD. Sarcopenia is one such risk stratification tool that has been associated with postoperative outcomes in patients undergoing abdominal surgery. Currently, however, there are no studies assessing this in older patients with IBD, and no standardized way to assess muscle mass and density based on routine preoperative imaging in IBD. Therefore, the goal of this proposal is to determine the cross-sectional measure of muscle that is most predictive of postoperative complications among older adults with IBD, and to build a preoperative risk stratification tool that combines cross-sectional imaging assessments of muscle with known IBD and surgical risk factors. A retrospective review of all patients with IBD ≥ 60 years of age who have undergone IBD-related surgery will be performed, measuring preoperative Total Psoas Index, Skeletal Muscle Index, and Hounsfield Unit Average Calculations on imaging. Our primary outcome will be a 30-day composite of postoperative mortality and major complications. A multivariable model combining the optimal cross-sectional measure of muscle mass along with known surgical risk factors will then be used to predict the risk of postoperative complications among older adults with IBD. This will be the first study to assess sarcopenia in older adults with IBD, and will serve as the foundation for future risk stratification models in this subpopulation. As part of my career development, this award will generate preliminary data that can be used to inform prospective validation studies, incorporating additional measures of sarcopenia such as grip strength. Additionally, under the guidance of my mentorship team, I will simultaneously develop new skills in aging research that I can carry forward in subsequent studies at the intersection of gerontology and IBD.

项目摘要/摘要：炎症性肠病（IBD）由克罗恩病和溃疡性结肠炎组成，是一种慢性疾病最初认为主要是由免疫系统失调引起的疾病，治疗方法的改进、死亡率的降低和发病率的稳定已经改变了 IBD 的格局。未来十年，患有 IBD 的老年人（≥60 岁）预计将占到三分之一以上尽管如此，患有 IBD 的老年人经常被忽略。限制可用于做出最佳临床决策的数据是特别重要的一个领域。术前计划患有新发 IBD 的老年人 5 年手术发生率超过 20%，四与年轻患者相比，术后死亡率高出一倍，并且有三分之一的机会由于缺乏足够的术前风险而导致手术出现严重并发症。分层工具，通常会规定长期无效且可能有害的治疗方法希望避免手术，进一步增加这种手术风险，因此，术前进行充分的风险分层。工具对于改善患有 IBD 的老年人的护理至关重要。肌少症就是这样的风险分层之一。与接受腹部手术的患者术后结果相关的工具。然而，目前还没有研究评估老年 IBD 患者的这一点，也没有标准化的方法根据 IBD 的常规术前影像评估肌肉质量和密度。建议是确定最能预测术后的肌肉横截面测量值老年人 IBD 的并发症，并建立一个术前风险分层工具，结合对已知 IBD 和手术危险因素的肌肉进行横断面成像评估。将对所有接受过 IBD 相关手术的年龄≥ 60 岁的 IBD 患者进行审查，测量术前总腰肌指数、骨骼肌指数和亨斯菲尔德单位平均计算我们的主要结果是术后死亡率和主要并发症的 30 天综合结果。结合了肌肉质量的最佳横截面测量的多变量模型。然后利用已知的手术风险因素来预测老年人术后并发症的风险这将是第一项评估患有 IBD 的老年人肌肉减少症的研究，并将作为作为我职业发展的一部分，这为该亚群的未来风险分层模型奠定了基础。奖项将生成可用于为前瞻性验证研究提供信息的初步数据，其中包括在我的指导下，还进行了肌肉减少症的其他测量，例如握力。团队，我将同时开发衰老研究的新技能，可以在后续研究中发扬光大位于老年学和 IBD 的交叉点。