Kamil Malshy, Stephen Schmit, Borivoj Golijanin, Benjamin Ahn, John Morgan, Amir Farah, Kennon Miller, Dragan Golijanin, Madeline Cancian
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Multivariable Cox and logistic regression analyses adjusted for age and the Charlson Comorbidity Index (CCI) to assess mortality risk.</p><p><strong>Results: </strong>Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, <i>p</i> < 0.001) and had higher median CCI (4.8 vs 3; <i>p</i> < 0.001).In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, <i>p</i> = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, <i>p</i> = 0.325; HR 1.35, 95% CI 0.70-2.61, <i>p</i> = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI.</p><p><strong>Conclusions: </strong>Despite a mild trend, none of the sarcopenia models were able to predict long-term mortality in FG patients in our cohort. This well-known, cost-effective nutritional predictor still requires further research to optimize its utilization in the FG patient population.</p>","PeriodicalId":23574,"journal":{"name":"Urologia Journal","volume":" ","pages":"3915603251318502"},"PeriodicalIF":0.8000,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Harnessing radiomics and nutritional metrics to predict long-term survival in Fournier's gangrene patients.\",\"authors\":\"Kamil Malshy, Stephen Schmit, Borivoj Golijanin, Benjamin Ahn, John Morgan, Amir Farah, Kennon Miller, Dragan Golijanin, Madeline Cancian\",\"doi\":\"10.1177/03915603251318502\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To evaluate the association of traditional and novel nutritional measurements with survival in Fournier's gangrene (FG) patients.</p><p><strong>Methods: </strong>We reviewed records of FG patients from our tertiary center (Jan 2013-Jan 2022). Radiomic sarcopenia parameters (Psoas Muscle Area [PMA], Roundness, Solidity, and calculated PMA-Index) were measured from admission CT scans at the L3 level using ImageJ software. We assessed sarcopenia's impact on survival through three analyses: Model 1 used a PMI below the sex-adjusted median; Models 2 and 3 used published cutoffs. Kaplan-Meier curves were used to compare survival between sarcopenic and non-sarcopenic patients. Multivariable Cox and logistic regression analyses adjusted for age and the Charlson Comorbidity Index (CCI) to assess mortality risk.</p><p><strong>Results: </strong>Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, <i>p</i> < 0.001) and had higher median CCI (4.8 vs 3; <i>p</i> < 0.001).In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, <i>p</i> = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, <i>p</i> = 0.325; HR 1.35, 95% CI 0.70-2.61, <i>p</i> = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI.</p><p><strong>Conclusions: </strong>Despite a mild trend, none of the sarcopenia models were able to predict long-term mortality in FG patients in our cohort. 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引用次数: 0
摘要
目的：评价富尼耶坏疽（FG）患者传统和新型营养测量方法与生存的关系。方法：回顾我院三级中心（2013年1月- 2022年1月）FG患者的记录。使用ImageJ软件从入院CT扫描的L3层测量放射学肌肉减少症参数（腰肌面积[PMA]，圆度，实心度和计算的PMA指数）。我们通过三个分析评估了肌肉减少症对生存的影响：模型1使用低于性别调整中位数的PMI；模型2和模型3采用公布截止值。Kaplan-Meier曲线用于比较肌肉减少症和非肌肉减少症患者的生存率。多变量Cox和logistic回归分析调整了年龄和Charlson合并症指数（CCI）来评估死亡风险。结果：在130名男性和31名女性（82%为白人）中，60名患者（37.3%）在中位随访2.2年（IQR 0.9-4.4）后死亡。30天生存率为94%，90天生存率为92%，1年生存率为80%，2年生存率为77%，5年生存率为56%。非幸存者年龄较大（中位年龄63 vs 55.1岁，p p p = 0.196）。模型2和模型3结果相似(HR 1.41, 95% CI 0.70-2.84, p = 0.325；HR 1.35, 95% CI 0.70-2.61, p = 0.364)。当调整CCI和年龄时，没有一个模型是显著的。幸存者具有更好的传统代谢谱，包括较高的白蛋白（3.1vs 2.7 g/dL）、血红蛋白（12.4vs 11.4 g/dL）和较低的肌酐（1.39 vs 2.1 mg/dL）；然而，当调整年龄和CCI时，这些都不显著。结论：尽管有轻微的趋势，但在我们的队列中，没有一个肌少症模型能够预测FG患者的长期死亡率。这一众所周知的、具有成本效益的营养预测指标仍需要进一步研究，以优化其在FG患者群体中的应用。
Harnessing radiomics and nutritional metrics to predict long-term survival in Fournier's gangrene patients.
Purpose: To evaluate the association of traditional and novel nutritional measurements with survival in Fournier's gangrene (FG) patients.
Methods: We reviewed records of FG patients from our tertiary center (Jan 2013-Jan 2022). Radiomic sarcopenia parameters (Psoas Muscle Area [PMA], Roundness, Solidity, and calculated PMA-Index) were measured from admission CT scans at the L3 level using ImageJ software. We assessed sarcopenia's impact on survival through three analyses: Model 1 used a PMI below the sex-adjusted median; Models 2 and 3 used published cutoffs. Kaplan-Meier curves were used to compare survival between sarcopenic and non-sarcopenic patients. Multivariable Cox and logistic regression analyses adjusted for age and the Charlson Comorbidity Index (CCI) to assess mortality risk.
Results: Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, p < 0.001) and had higher median CCI (4.8 vs 3; p < 0.001).In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, p = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, p = 0.325; HR 1.35, 95% CI 0.70-2.61, p = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI.
Conclusions: Despite a mild trend, none of the sarcopenia models were able to predict long-term mortality in FG patients in our cohort. This well-known, cost-effective nutritional predictor still requires further research to optimize its utilization in the FG patient population.
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