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

• 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
• 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' 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

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： 由克罗恩病和溃疡性结肠炎组成的炎症性肠病（IBD）是一种慢性疾病 由免疫系统的失调引起。最初被认为主要是年轻人的疾病 改进的治疗方法，降低死亡率和稳定的事件已改变了IBD的景观。在 接下来的十年，IBD的老年人（≥60岁）预计将建造超过三分之一的 整个IBD患者人数。尽管如此，研究研究通常会省略IBD的老年人 限制可用的数据以做出最佳的临床决策。一个区域尤其重要，是 术前计划。新发作IBD的老年人患有超过20％的5年手术，四个 与年轻患者相比，术后死亡率的几率更高，三分之一的机会 由于手术而经历重大并发症。由于缺乏足够的术前风险 分层工具，临床医生经常规定长时间无效且可能有害的疗法 希望避免手术，进一步增加了这种手术风险。那是足够的术前风险分层 工具对于改善IBD老年人的护理至关重要。肌肉减少症就是这样的风险分层 与接受腹部手术的患者术后结局有关的工具。 但是，目前尚无研究对IBD老年患者进行评估，也没有标准化的方法 基于IBD中常规术前成像评估肌肉质量和密度。因此，目标的目标 建议是确定最可预测术后肌肉的肌肉的横断面测量 IBD老年人的并发症，并建立一个结合的术前风险分层工具 具有已知IBD和手术风险因素的肌肉的横断面成像评估。回顾性 对所有接受IBD相关手术的IBD≥60岁患者的审查， 测量术前总PSOA指数，骨骼肌指数和Hounsfield单位平均计算 关于成像。我们的主要结果将是术后死亡率和主要的30天复合。 并发症。一个多变量模型，结合了沿着肌肉质量的最佳横截面测量 随后将使用已知的手术危险因素来预测较老的术后并发症的风险 成人IBD。这将是评估IBD老年人肌肉减少症的第一项研究，并将作为 该亚群中未来风险分层模型的基础。作为我职业发展的一部分， 奖项将产生初步数据，可用于告知潜在验证研究，并合并 肌肉减少症（例如握力强度）的其他措施。此外，在我的心态的指导下 团队，我将简单地开发新的技能，以在随后的研究中继续进行衰老研究 在老年病和IBD的交叉点上。