Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis. Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables. The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm2/m2 for males and 2.89 cm2/m2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257). PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

中文翻译：

---

低腰肌指数是下消化道穿孔的不良预后因素：一项单中心回顾性队列研究

已经报道了各种身体成分指数作为不同癌症的预后因素。然而，尚不清楚需要紧急手术和多学科治疗的下消化道穿孔后身体成分是否影响预后。这项研究检查了可以通过计算机断层扫描（CT）轻松而快速地进行测量的身体成分评估是否对预测预后有用。受试者包括64位在紧急手术后最终诊断为穿孔的患者，用于术前诊断下消化道穿孔和穿透。将他们分为生存组和非生存（院内死亡率）组并进行比较。身体成分指数（腰肌指数（PMI）；腰肌衰减（PMA）；皮下脂肪组织指数（SATI）内脏脂肪组织指数（VATI）；术前CT测量内脏与皮下脂肪面积比（VSR）。量化第三腰椎水平的腰大肌横截面积。使用接收器工作特性曲线分析来计算最佳截止值。通过多因素Logistic回归分析研究了不良预后因素，其中包括患者因素，围手术期因素，术中因素和身体成分指标作为解释变量。穿孔的原因是恶性疾病12例（18.7％），良性疾病52例（81.2％）。最常见的原因是大肠憩室。64例患者的急诊手术导致52例患者存活，12例死亡。在多因素logistic回归分析中，不良预后的独立预测因素为顺序器官衰竭评估评分（比值1.908； 95％置信区间（CI）1.235-3.681； P = 0.0020）和PMI（比值13.478； 95％CI 1.342-332.690）。 ； P = 0.0252）。男性的临界PMI为4.75 cm2 / m2，女性为2.89 cm2 / m2。在幸存者中，低PMI组（29天）的住院时间显着长于高PMI组（22天，p = 0.0257）。PMI可以通过CT轻松确定，并可以快速评估下消化道穿孔后的预后。男性的临界PMI为4.75 cm2 / m2，女性为2.89 cm2 / m2。在幸存者中，低PMI组（29天）的住院时间显着长于高PMI组（22天，p = 0.0257）。从CT可以轻松确定PMI，并可以快速评估下消化道穿孔后的预后。男性的临界PMI为4.75 cm2 / m2，女性为2.89 cm2 / m2。在幸存者中，低PMI组（29天）的住院时间显着长于高PMI组（22天，p = 0.0257）。从CT可以轻松确定PMI，并可以快速评估下消化道穿孔后的预后。