Impact of myopenia and myosteatosis on postoperative outcome and recurrence in Crohn’s disease

Introduction Myopenia and myosteatosis have been proposed to be prognostic factors of outcomes for various diseases, especially in cancer, but their exact role in Crohn´s disease (CD) is unknown. Since magnetic resonance imaging (MRI) scans are widely used in the preoperative diagnostic for CD, skeletal muscle mass quantity and quality could be adequate indicators.

Aims The aim of this study is to evaluate the impact of myopenia and myosteatosis on postoperative course and recurrence after ileocecal resection in patients with CD.

Methods A retrospective review of 347 CD patients undergoing ileocecal resection over a decade at our tertiary referral center was performed. Finally, 223 patients with available high quality preoperative MRI scans were analyzed. Patient demographics, postoperative outcomes and recurrence rates were recorded. Skeletal muscle area (SMA) and muscle signal intensity were measured using an established image-analysis method at the third lumbar vertebra (L3) level on MRI cross-sectional images in order to assess myopenia and myosteatosis, respectively. In addition, the skeletal muscle index (SMI) was determined by normalizing the dorsal SMA for the body height.

Results The median SMA was 71.5 cm² (IQR: 57.0 - 93.0). None of the radiological variables for myopenia or myosteatosis (SMA, SMI, myosteatosis index) showed an association with postoperative complications. In univariate analysis, patients with a longer hospital stay had a higher myosteatosis index (median 0.128 vs. 0.116; p = 0.008), and SMI was significantly lower in patients with Crohn’s recurrence (median 25.7 vs. 22.5 cm²/m²; p = 0.047). In multivariate regression analysis, length of hospital stay was not associated with myosteatosis and Crohn’s recurrence was not associated with myopenia.

Conclusion None of the MRI based indices for myopenia or myosteatosis are reliable predictors of postoperative outcomes or recurrence in patients with Crohn’s disease undergoing ileocecal resection. Further studies considering also skeletal muscle function in parallel to muscle mass may be required to evaluate adequately myopenia and myosteatosis in Crohn’s disease.

Publication History

Article published online:
07 September 2021