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Ann. Neurol., 06 September 2023 | https://doi.org/10.1002/ana.26775 Association Between Fat Depletion and Prognosis of Amyotrophic Lateral Sclerosis: CT-based Body Composition Analysis.

Seok-Jin Choi 1^,2, Soon Ho Yoon ³, Jung-Joon Sung ^{# 1}, Jong Hyuk Lee ^{# 3}

¹Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.

²Center for Hospital Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

³Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.

^#Contributed equally.

CORRESPONDING AUTHORS: Jung-Joon Sung MD, PhD, Jong Hyuk Lee MD, PhD

Abstract

Objective: To investigate the prognostic value of adipopenia and sarcopenia in patients with amyotrophic lateral sclerosis (ALS).

Methods: Consecutive ALS patients with abdominal CT were retrospectively identified at a single tertiary hospital between January 2010 and July 2021. Deep learning-based volumetric CT body composition analysis software was used to obtain abdominal waist fat volume, fat attenuation, and skeletal muscle area at the L3 level, then normalized to the fat volume index (FVI) and skeletal muscle index (SMI). Adipopenia and sarcopenia were defined as the sex-specific lowest quartile and SMI reference values, respectively. The associations of CT-derived body composition parameters with clinical variables such as body mass index (BMI) and creatinine were evaluated by Pearson correlation analyses, and associations with survival were assessed using multivariable Cox regression analysis.

Results: Eighty subjects (40 men; 65.5±9.4 years) were investigated (median interval between disease onset and CT examination, 25 months). The mean BMI at the CT examination was 20.3±4.3 kg/m2 . BMI showed a positive correlation with both FVI (R=0.70, P<.001) and SMI (R=0.63, P<.001), and the serum creatinine level was associated with SMI (R=0.68, P<.001). After adjusting for sex, age, King's stage, BMI, creatinine, progression rate, and sarcopenia, adipopenia was associated with shorter survival (hazard ratio [HR]: 5.94, 95% confidence interval [CI]: 1.01, 35.0, P=.049). In a subgroup analysis for subjects with nutritional failure (stage 4a), the HR of adipopenia was 15.1 (95% CI: 2.45, 93.4, P=.003).

Interpretation: Deep learning-based CT-derived adipopenia in patients with ALS is an independent poor prognostic factor for survival.

논문정보

형식Research article
게재일2023년 09월 (BRIC 등록일 2023-09-14)
연구진국내 연구진
분야 의약학 > 응용의학

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