Prognostic Utility of the Preoperative Cachexia Index in Patients Undergoing Emergency Laparotomy

TL;DR

A new index called the cachexia index helps predict survival chances in patients undergoing emergency abdominal surgery, based on muscle mass, nutrition, and inflammation.

Contribution

The study demonstrates that the preoperative cachexia index is a novel and effective predictor of mortality in emergency laparotomy patients.

Findings

Patients with a low cachexia index had significantly higher in-hospital mortality (20.0%) compared to those with a high index (5.0%).

The cachexia index was an independent predictor of in-hospital mortality alongside age and chronic renal failure.

One-year mortality was higher in the low cachexia index group (34.2%) compared to the high index group (13.4%).

Abstract

Emergency laparotomy is associated with high morbidity and mortality rates. The cachexia index, an objective index that incorporates muscle mass, nutrition, and inflammation, has been shown to predict outcomes in patients with cancer. The present study aimed to investigate the prognostic significance of preoperative cachexia index in patients undergoing emergency laparotomy.

This retrospective study included data from 404 patients who underwent emergency laparotomy between January 2013 and March 2023. The cachexia index was calculated as: (psoas muscle index × albumin level [g/dL]/neutrophil‐to‐lymphocyte ratio). Patients were divided into low and high cachexia index groups based on sex‐specific receiver operating characteristic curve derived cut‐off values.

Of 404 patients (median age, 74 years [44.6% female]), 120 (30%) exhibited a low cachexia index. In‐hospital mortality was significantly higher in the low cachexia index group (20.0%) than that in the high cachexia index group (5.0%) (p < 0.01). Multivariate analysis revealed that age, chronic renal failure and cachexia index were independent predictors of in‐hospital mortality. One‐year mortality was also higher in the low versus high cachexia index group (34.2% vs. 13.4%, respectively; p < 0.01).

Preoperative cachexia index was a useful marker for predicting mortality after emergency laparotomy and may aid in risk stratification and perioperative decision‐making.

The preoperative cachexia index, incorporating muscle mass, nutritional status, and inflammation, predicts in‐hospital and one‐year mortality in patients undergoing emergency laparotomy. This simple index may aid in risk stratification and perioperative decision‐making in high‐risk surgical patients.

Figures