Osteosarcopenia-aneurysm score predicts long-term survival following endovascular repair for abdominal aortic aneurysm.

Abstract

Introduction: Estimated prognosis plays an important role in the operative decision-making process in the management of abdominal aortic aneurysms (AAAs). We aimed to develop a composite score to predict overall survival following endovascular aneurysm repair (EVAR) for AAAs based on bone mineral density (BMD) and psoas muscle index (PMI).

Methods: This was a single-center, retrospective cohort study of 237 patients undergoing primary EVAR for AAA between 2016 and 2019. BMD was assessed by measuring the Hounsfield units (HUs) of the 11th thoracic vertebra on preoperative computed tomography; a BMD value of <110 HU was considered osteoporosis. The PMI was used in the diagnosis of sarcopenia.

Results: A multivariable analysis showed that age (hazard ratio [HR], 1.07, 95% confidence interval [CI], 1.04-1.11; P < 0.001), aneurysm diameter (HR, 1.05, 95% CI, 1.02-1.08; P = 0.001), osteoporosis (HR, 1.69, 95% CI, 1.12-2.55; P = 0.013), and sarcopenia (HR, 2.20, 95% CI, 1.34-3.60; P = 0.002) were found to be independent risk factors for all-cause mortality. Osteosarcopenia-aneurysm score (OSAS) was defined as the sum of the following factors: elderly (≥ 80 years), large aneurysm (≥ 55 mm), osteoporosis, and sarcopenia. In a receiver-operating characteristic analysis in predicting of 5-year mortality, the area under the curve (AUC) for the OSAS was comparable to that for the Glasgow Aneurysm Score (GAS) (AUC for OSAS: 0.75, 95% CI, 0.69-0.82 vs. AUC for GAS: 0.74, 95% CI, 0.67-0.81; P = 0.69).

Conclusion: We believe that the OSAS is applicable to predict long-term survival following EVAR.