CT-defined body composition as a prognostic factor in multiple myeloma.

OBJECTIVES: Body composition assessment is comprised by skeletal muscle mass (SMM) and subcutaneous and visceral adipose tissue (SAT and VAT) and can be quantified by imaging. It can be predictive of several clinically outcomes in patients with hematological diseases. Our aim was to establish the effect of body composition parameters on overall survival (OS) and progression-free survival (PFS) in patients with multiple myeloma (MM). MATERIALS AND METHODS: All patients with MM were retrospectively analyzed between 2009 and 2019. One hundred twenty-three patients were included into the analysis. Whole-body computed tomography (CT) was used to calculate SMM, VAT, and SAT. RESULTS: Overall, 22 patients (17.9%) of the patient sample died. Forty patients were sarcopenic (32.5%), 79 patients were visceral obese (64.2%), and 18 patients (14.6%) were sarcopenic obese. Parameter of body composition did not influence OS: sarcopenia, hazard ratio (HR) = 1.3 (95% CI 0.50-3.34), p = .59; visceral obesity, HR = 1.6 (95% CI 0.70-3.76), p = .26; sarcopenic obesity, HR = 2.3 (95% CI 0.90-5.63), p = 0.08. Patients with infectious complications showed higher VAT values. CONCLUSIONS: CT-defined body composition parameters have no influence on survival in patients with MM undergoing autologous stem-cell therapy. These results corroborate previous smaller studies that body composition might have a limited role in this tumor entity. VAT may predict the occurrence of infectious complications.

Low skeletal muscle mass defined by thoracic CT as a prognostic marker in acute pulmonary embolism.

OBJECTIVE: Sarcopenia defined as low skeletal muscle mass (LSMM) is associated with several clinically relevant factors in people who are critically ill. The aim of the present study was to analyze the role of LSMM derived from thoracic computed tomography (CT) for prediction of mortality and prognosis of acute pulmonary embolism (PE). METHODS: The clinical database of our department was retrospectively screened for patients with acute PE between 2013 and 2017. Overall, 234 patients were included in the analysis. LSMM was assessed on axial slides at the thoracic vertebra 5 (Th5) level of contrast-enhanced pulmonary angiography thoracic CT. The skeletal muscle index (SMI) was calculated by adjusting the muscle area to height. All-cause 30-d mortality was used as a primary outcome. RESULTS: Overall, 64 participants (27.4% of the sample) died. SMI was slightly higher for survivors than non-survivors (57.7 ± 11.9 versus 55.6 ± 14.3 cm2/m2; P = 0.07). SMI was associated with 30-d mortality in univariate as well as multivariate analysis (respective hazard ratios and 95% CI: 1.06, 1.03-1.09; 1.08, 1.04-1.11). CONCLUSIONS: SMI at Th5 derived from thoracic CT has a relevant effect on 30-d mortality in people with acute PE and should be included in the clinical routine.

Role of visceral fat areas defined by thoracic CT in acute pulmonary embolism.

OBJECTIVE: Visceral adipose tissue (VAT) has been established as an important parameter of body composition. It can be assessed by imaging modalities like computed tomography (CT). The purpose of the present study was to analyse the prognostic role of VAT derived from thoracic CT in patients with acute pulmonary embolism (PE). METHODS: The clinical database of our center was retrospectively screened for patients with acute PE between 2014 and 2017. Overall, 184 patients were included into the analysis. VAT was assessed on axial slices of the thoracic CT at the level of the first lumbar vertebra. Clinical scores, serological parameters, need for intubation, ICU admission and 30 days mortality were assessed. RESULTS: Using the previously reported threshold of 100 cm² for visceral obesity definition 136 (73.9%), patients were considered as visceral obese. There was a moderate correlation between VAT and BMI (r = 0.56, p < 0.0001). There was also a moderate correlation between VAT and body height (r = 0.41, p =< 0.0001). Of all investigated clinical scores relating to acute PE, only the GENEVA score correlated weakly with VAT (r = 0.15, p = 0.04). There were significant correlations between VAT and creatinine (r = 0.38, p < 0.0001) and Glomerular filtration rate (r = -0.21, p = 0.005). No associations were identified for VAT and mortality or visceral obesity and mortality. CONCLUSION: VAT was not associated with mortality in patients with acute pulmonary embolism. ADVANCES IN KNOWLEDGE: Visceral obesity is frequent in patients with acute pulmonary embolism but it is not associated with mortality.