| Objectives:1.The L3 skeletal muscle index(L3SMI)was used to classify elderly patients wi th chronic heart failure(CHF)into a skeletal muscle reduction group and a non-skele tal muscle reduction group and compare the differences in clinical indicators and pro gnostic characteristics between the two groups of patients.2.To assess the diagnostic efficacy of the L4 skeletal muscle fat index(SMFIpsoa s)in elderly patients with chronic heart failure(CHF)combined with sarcopenia and to evaluate the predictive efficacy of L4 skeletal muscle fat index(SMFIPsoas)on rea dmission in elderly patients with chronic heart failure(CHF).Methods:Elderly patients admitted to the Affiliated Hospital of Yangzhou University for c hronic heart failure from June 01,2020 to May 31,2021 were selected,and baseline data,laboratory indicators,and prognostic indicators were collected from patients.Th e included patients were followed up for 1 year by telephone follow-up and readmiss ion within 1 year was collected.Using CT imaging data,the total area of muscles at the L3 level was measured and the area and density of the psoas major muscle at the lumbar 4 vertebral level was measured.L3 skeletal muscle index(L3SMI)and skeletal muscle fat index(SM FlPsoas)were calculated.All enrolled patients were divided into a skeletal muscle redu ction group(89)and a non-skeletal muscle reduction group(21)according to L3SMI.Univariate analysis was performed to compare the baseline data,clinical characteristi cs,laboratory indices and prognosis of the two groups,and Kaplan-Meier(K-M)surv ival curves were used for survival analysis.Logistic regression analysis was applied to analyze the predictive efficacy of risk factors and indicators for readmission in elderly CHF patients,and subgroup analysi s was performed on all enrolled patients to evaluate the predictive efficacy of SMFIPs oas in different cohorts of the population.The subject operating characteristic curve(ROC)and the Jorden index were used to evaluate the diagnostic efficacy of SMFIPso as for the diagnosis of combined sarcopenia in elderly patients with CHF and the sen sitivity,specificity and critical value of the predictive efficacy of SMFIPsoas for readm ission in elderly patients with CHF.Pearson and Spearman correlation analysis was u sed to compare the correlation between the two groups of variables according to the nature of the variables.Results:1.A total of 110 elderly patients with CHF were included in this study,58(52.73%)were male patients with an age distribution between 62 and 92 years,with a m ean age of 78.28 years,and 52(47.27%)were female patients with an age distributi on between 61 and 93 years,with a mean age of 79.12 years,there was no significa nt difference in age between the two groups.The smoking rate and drinking rate of males were significantly higher than those of females.In terms of comorbid diseases,the prevalence rates of hypertension,diabetes and coronary heart disease in males w ere significantly higher than those in females.There was no significant difference in BMI and L3SMI between the two groups,but the SMFIPsoas of male was higher.2.In terms of laboratory indexes,WBC,NEU%,D-D,Hb,BUN and Scr in mal es were higher than those in females,while LYM,Alb and EF in males were lower than those in females.There was no significant difference in prognostic indexes betw een males and females in hospitalization days.3.There were 89 patients with skeletal muscle loss(80.91%),54 males(60.67%)and 35 females(39.33%),with a mean age of 79.26 years;21 patients with non-skel etal muscle loss(19.09%),4 males(19.05%)and 17 females(80.95%),with a mean age of 76.19 years,There was no significant difference in age between the two grou ps(p>0.05),and there was no significant difference in smoking rate,drinking rate an d co-morbidity between the two groups(p>0.05).;the skeletal muscle reduction group had a higher percentage of males,a lower BMI and higher SMFIPsoas(p<0.05).4.Regarding laboratory indices,WBC,NEU%,D-D,and BNP were higher in the skeletal muscle reduction group,while Hb,Alb,PLT,and EF were lower(p<0.05),and no significant differences were seen between the two groups in LYM,BUN,and Scr(p>0.05);regarding prognostic indices,patients in the skeletal muscle reduction g roup had a higher readmission rate and a shorter survival time without acute exacerb ation during follow-up(p<0.05);K-M survival analysis also showed a shorter surviv al time without acute exacerbation in the skeletal muscle reduction group(p<0.05).5.The results of multifactorial logistic regression analysis suggested that SMFIPsoas[OR 1.124(1.038,1.217)],PLT[OR 0.978(0.962,0.995)]were independent risk factors for readmission in elderly patients with CHF after excluding confounding factor infect ions(p<0.05);Subsequent subgroup analysis suggested that SMFIPsoas had good predic tive efficacy for readmission in elderly CHF patients in the subgroups of men,wome n,history of smoking,no history of smoking,and with or without comorbid hyperten sion,diabetes,coronary artery disease,cerebral infarction,and atrial fibrillation.(p<0.05),and all were similar to the overall population in terms of SMFIPsoas The predicti ve efficacy of SMFIPsoas was similar to that of the overall population.6.ROC curve analysis showed that the area under the curve(AUC)of SMFIPsoas for the diagnosis of combined skeletal muscle reduction in elderly CHF patients was 0.829 in male patients,with a best critical value of 58.10,sensitivity of 59.3%and s pecificity of 100%;the area under the curve(AUC)of SMFIPsoas for the prediction o f combined skeletal muscle reduction in elderly CHF patients in female patients was 0.708,with a best critical value of 43.57,sensitivity of 54.3%and specificity of 88.2%.)was 0.708,with a best critical value of 43.57,sensitivity of 54.3%,and specif icity of 88.2%;ROC curve analysis showed that the area under the curve(AUC)of SMFIPsoas predicting readmission in elderly CHF patients was 0.841,with a best critic al value of 49.42,sensitivity of 96.8%,and specificity of 65.8%;subsequent correlati on analysis showed that SMFIPsoas were positively correlated with WBC,NEU%,Hb,D-D,BUN,age,sex,smoking,alcohol consumption,hypertension,coronary artery dis ease,cerebral infarction,and atrial fibrillation(p<0.05).SMFIPsoas were negatively cor related with PLT,Alb,and EF(p<0.05).Conclusions:1.In elderly CHF patients,no significant differences were seen between male and female BMI and L3SMI,but males had higher SMFIPsoas,corresponding to worse ge neral condition and poorer prognosis of the patients.2.SMFIPsoas can be used as a new indicator for the diagnosis of sarcopenia and can be used to assess the risk of readmission in elderly CHF patients.3.SMFIPsoas predicted skeletal muscle reduction cutoff values of 58.10 for men a nd 43.57 for women,respectively,in elderly CHF patients.the optimal threshold valu e for SMFIPsoas to predict readmission in elderly CHF patients was 49.42.4.Patients with CHF in the skeletal muscle reduction group had worse general c ondition,worse disease,and worse prognosis SMFIPsoas,and PLT were independent fa ctors influencing readmission in elderly CHF patients.5.SMFIPsoas were positively correlated with WBC,NEU%,Hb,D-D,age,gender,smoking,alcohol consumption,hypertension,coronary artery disease,cerebral infarcti on,and atrial fibrillation.SMFIPsoas were negatively correlated with PLT,Alb,and E F. |
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