title: Skeletal muscle percentage: a protective factor for postoperative morbidity in Crohn's disease patients with severe malnutrition.
abstract: BACKGROUND
  There are no appropriate variables for predicting postoperative morbidity in Crohn's disease (CD) patients with severe malnutrition. We examined a retrospective cohort to clarify these.
  
  
  METHODS
  Between 2005 and 2013, 138 CD patients with severe malnutrition underwent elective intestinal resection after preoperative management, consisting of nutritional support, abscess drainage, intravenous antibiotics, steroids tapering, and infliximab weaning, as appropriate. The severity of postoperative morbidity (within the first 30 days) was examined according to the Clavien-Dindo classification system.
  
  
  RESULTS
  After a median duration of 26 days of preoperative management, Crohn's disease activity index (CDAI) and C-reactive protein (CRP) significantly decreased, and body mass index (BMI), skeletal muscle percentage (SMP), body fat percentage (BFP), albumin, prealbumin, and hemoglobin significantly increased (P < 0.001). Postoperative overall morbidities occurred in 28 (20.3%) patients including 15 (10.8%) major complications (Clavien-Dindo classification ≥ III). In the multivariate logistic regression analysis, preoperative CRP (P = 0.044, OR 1.156, 95% CI 1.004-1.331) was a significantly independent risk factor for overall complications, and preoperative SMP (P = 0.002, OR 0.487, 95% CI 0.307-0.772) and BFP (P = 0.036, OR 0.691, 95% CI 0.490-0.996) were significantly independent protective factors. Notably, only preoperative SMP (P = 0.002, OR 0.588, 95% CI 0.422-0.820) was a significantly independent protective factor for major complications, and our threshold of SMP was 24.3% (P < 0.001, sensitivity 83.7%, specificity 95.9%).
  
  
  CONCLUSIONS
  Preoperative SMP is a protective factor for postoperative overall and major complications in CD patients with severe malnutrition and deserves further study.
authors: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, No. 305 East Zhongshan Road, Nanjing, Jiangsu, China.
authors: Wei
authors: W
authors: Zhang
authors: Weiming
authors: W
authors: Zhu
authors: Jianan
authors: J
authors: Ren
authors: Lugen
authors: L
authors: Zuo
authors: Xiuwen
authors: X
authors: Wu
authors: Jieshou
authors: J
authors: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal; D018529:Nutritional Support; D011183:Postoperative Complications; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D002097:C-Reactive Protein; D000069285:Infliximab