Myosteatosis as a Prognostic Marker for Postoperative Mortality in Adult Patients Undergoing Surgery in General—A Systematic Review
Bibliographic record
Abstract
Background: Assessing frailty is important in treating surgical patients to predict peri- and postoperative events like complications or mortality. The current standard is not optimal; therefore, new prognostic markers are being evaluated to enrich the current frailty assessment. One of these new markers is fat degeneration of the psoas muscle (myosteatosis). This can be assessed by measuring the psoas muscle density (PMD) with computed tomography (CT). The aim of this review is to investigate PMD, and, thus, myosteatosis, as a prognostic marker for postoperative mortality in adult patients undergoing general surgery. Methods: An electronic search was performed in PubMed to identify relevant studies associating PMD with postoperative mortality. The looked-upon period for mortality to occur did not matter for this review. The looked-upon outcome measure for this review was the hazard ratio. Results: From 659 potential articles from PubMed, 12 were included, for a total of 4834 participants. Articles were excluded when not focused on PMD, if the type of intervention was not specified, and when imaging other than with CT on the level of the third vertebra was performed. The included articles were assessed for bias with the Newcastle–Ottawa Scale (NOS). PMD was, after multivariable analyses, identified as an independent significant prognostic marker for several surgical cardiovascular interventions when we looked at the 5-year mortality rate and for fenestrated branched endovascular aortic repair (F-BEVAR) a slight significant protective correlation between postoperative mortality and PMD (when divided by psoas muscle area (PMI)) when we looked at the 30-day and 3-year mortality. Also, PMD was identified as an independent significant prognostic marker for a variety of surgical gastrointestinal interventions when we looked at 30-day/90-day/1-year/3-year/5-year mortality. PMD was not identified as a significant prognostic marker in urologic surgery. Conclusion: Myosteatosis has the potential to be a valuable contribution to the current frailty assessment for patients undergoing cardiovascular, gastrointestinal, or urologic surgery. However, more research must be conducted to further strengthen the prognostic value of myosteatosis, with special attention to, e.g., gender- or age-specific interpretations of the results.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".