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Prognostic Value of Sarcopenia for Long-Term Mortality in Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

Cho, Woo Hyun*; Choi, Yoon Young; Byun, Ki Sup*; Lee, Seung Eun*; Jeon, Doosoo*; Kim, Yun Seong*; Han, Junhee; Yeo, Hye Ju*,§

doi: 10.1097/MAT.0000000000001006
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It is unclear whether sarcopenia is responsible for long-term mortality in patients who require extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. We retrospectively reviewed 127 patients who underwent computed tomography imaging before initiating ECMO from June 2014 to November 2017. The patients were divided into two groups according to the skeletal muscle index (SMI): low SMI (n = 47) and high SMI (n = 80). Mean age was lower in the high SMI group than in the low SMI group (60.2 vs. 53.9 years, p = 0.002). Mean body mass index was higher in the high SMI group than in the low SMI group (21.6 vs. 24.1 kg/m2, p = 0.001). The mean Charlson comorbidity index (CCI) was lower in the high SMI group than in the low SMI group (3.0 vs. 2.2, p = 0.024). After propensity score matching for age and CCI score, no differences were observed in ECMO weaning success rate or hospital mortality between the two groups. However, the 1 year mortality rate was higher in the low SMI group than in the high SMI group (70.2% vs. 46.8%, p = 0.021). Multivariate analyses showed that renal replacement therapy (odds ratio [OR] 3.99, 95% confidence interval [CI] 1.74–9.13, p = 0.001) and low SMI (OR 5.47, 95% CI 2.31–12.98, p < 0.001) were associated with 1 year mortality. Kaplan–Meier analyses revealed that a low SMI predicted mortality2 = 13.20, p < 0.001). Sarcopenia predicted worse 1 year mortality in patients who underwent respiratory ECMO.

From the *Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea

Department of Radiology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea

Department of Statistics, Hallym University, Gyeongsangnam-do, Republic of Korea

§Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Republic of Korea.

Submitted for consideration January 2019; accepted for publication in revised form March 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Woo Hyun Cho and Yoon Young Choi contributed equally to this work.

Correspondence: Hye Ju Yeo, Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Republic of Korea. Email: dugpwn@naver.com.

Copyright © 2019 by the American Society for Artificial Internal Organs