Myosteatosis as an independent predictor for all-cause and cardiac mortality in initial-dialysis patients: a multicenter, retrospective cohort study
Bibliographic record
Abstract
Background: Myosteatosis is associated with adverse prognosis in diseases. We aimed to establish thresholds for myosteatosis, assess its association with all-cause and cardiac mortality in initial dialysis patients, and construct a myosteatosis-based survival nomogram. assessed the predictive value of myosteatosis with all-cause and cardiac mortality in initial-dialysis patients, and constructed a myosteatosis-based survival nomogram. Methods: ) and Skeletal Muscle Density (SMD, Hounsfield Units [HU]) were measured at the third lumbar vertebra (L3) level by computed tomography (CT). Sex-specific SMI and SMD thresholds predicted all-cause mortality through the receiver operating characteristic (ROC) curves. The Cox models assessed myosteatosis-associated mortality risks. Survival prediction models were built using univariate and multivariate Cox proportional hazards regression in the training cohort, followed by internal and external validation. Results: Patients were predominantly aged 18-65 years (n = 298, 77.81%), with males comprising 60.84% (n = 233). All-cause mortality was 22.72% (n = 87), of which 52.87% (n = 46) were attributed to cardiac causes. Sex-specific SMD cutoffs for predicting all-cause mortality were 32.46 HU (AUC = 0.707) in males and 34.58 HU (AUC = 0.690) in females (both P < 0.05). Myosteatosis was associated with higher all-cause (36.7%) and cardiac mortality (19.8%) (both P < 0.001), and independently predicted both outcomes (all-cause mortality: HR = 3.203, 95% CI:1.937-5.296; cardiac mortality: HR = 3.418, 95% CI:1.718-6.802). The myosteatosis-based nomogram achieved a C-index of 0.761, validated in real-world data. Conclusion: Sex-specific myosteatosis thresholds (males: SMD ≤32.46 HU; females: ≤34.58 HU) derived from L3-CT independently predicted all-cause and cardiac mortality in initial-dialysis patients. The myosteatosis-based survival nomogram demonstrated moderate-to-good predictive accuracy and potential clinical utility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".