4. Results
low thoracic skeletal muscle mass, sarcopenia, thoracic SMI, TAVR, malnutrition
STILL, SARCOPENIA, SECONDARY, MALNUTRITION, REGRESSION
The main results of this secondary analysis of a randomized trial investigating the association of low thoracic skeletal muscle mass with different clinical and nutritional outcomes and with the response to nutritional treatment in patients at nutritional risk are as follows. First, we found significant and independent associations of the SMI with different nutritional parameters, including BMI, nutritional risk as assessed by the NRS 2002 and handgrip strength, suggesting that thoracic SMI is an additional nutritional parameter that may help to better characterize patients and identify patients at nutritional risk based on a routine examination. Second, the prognostic implications of low thoracic skeletal muscle mass were only moderate, with non-significant results in an adjusted regression analysis and with low area under the curve values. Third, there was little evidence that low thoracic skeletal muscle mass would help to identify patients that show a more pronounced response to nutritional support.Our study is important in regard to the current discussion about the use of GLIM criteria to diagnose malnutrition [Today, there is limited research on the usefulness of the SMI in thoracic CT scans to predict clinical outcomes. Nemec et al. showed an association of low SMI measured at T12 with longer hospital stays in a population of patients undergoing transcatheter aortic valve replacement (TAVR) [Currently, there is no well-defined cut-off value for SMI at level T12 for the diagnosis of sarcopenia. While some studies have suggested cut-off values based on their own patient populations, using these cut-offs in our cohort did not match well with the population, and >95% of patients would have been classified as having low SMI [Interesting, in the EFFORT study, there were more routine CT scans with T12 done compared to L3 CT scans (i.e., 663 vs. 519, respectively), suggesting that in clinical routine, thoracic scans may be more widely available in this population of medical inpatients. Still, our results do not support the use of the SMI in single cross-sectional images at level T12 for the definition of clinically relevant sarcopenia due to the lack of prognostic information derived from these measurements. Of note, L3 measurements also provided very little prognostic information in this analysis.This study has some strengths and limitations. EFFORT was based on a prospective, randomized, multicenter study, and therefore the population included for analyses was large and well characterized. To our knowledge, this was the first study to investigate an association between low SMI on thoracic CT scans with response to nutritional support in patients at nutritional risk. We have previously reported results of L3 measurements in the overall cohort and results may differ from this report that was limited to patients with available Th12 scans [