Sarcopenia em crianças e adolescentes submetidos ao transplante de células-tronco hematopoiéticas
Data
2023-10-24
Autores
Lewandowski, Cláudia Georgiadis 
Orientadores
Leite, Heitor Pons
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A sarcopenia, caracterizada pela diminuição da massa muscular, força e
função muscular, está associada a desfechos clínicos adversos. No entanto, a
prevalência de sarcopenia em pacientes pediátricos submetidos ao transplante de
células-tronco hematopoiéticas (TCTH) e o efeito da resposta inflamatória na perda
de força muscular nessa população são desconhecidos. Objetivou-se estimar a
prevalência de sarcopenia na admissão e seus fatores clínicos associados em
crianças e adolescentes submetidos ao TCTH e determinar em que medida a resposta
inflamatória sistêmica durante a hospitalização afeta a força muscular. Métodos:
Estudo de coorte prospectivo de 80 pacientes com idades entre 6 e 18 anos
submetidos ao TCTH que foram acompanhados de maio de 2019 a fevereiro de 2023.
As variáveis de desfecho foram a prevalência de sarcopenia na admissão e a perda
da força de preensão palmar (FPP) durante a internação. As principais variáveis
explicativas foram idade, sarcopenia, estado nutricional e inflamação sistêmica
medida pelas concentrações séricas de proteína C-reativa, albumina e ferritina.
Equações de estimação generalizadas foram utilizadas para analisar a associação
entre as variáveis explicativas e de desfecho na admissão e 14 dias após o TCTH.
Resultados: Na admissão hospitalar, 11% dos pacientes apresentavam sarcopenia.
Sexo feminino, sarcopenia na admissão (β coeficiente 0,70; IC 95%, -1,30; -0,12;
p=0,018) e concentração sérica de PCR (coeficiente β -0,10; IC, -0,16; -0.04; p=0,001)
associaram-se à perda da FPP. Conclusão: A sarcopenia na admissão e o grau de
resposta inflamatória sistêmica estão associados à diminuição da FPP durante a
hospitalização em crianças e adolescentes submetidos ao TCTH. A identificação de
fatores relacionados à perda de força poderá ajudar na intervenção precoce para
prevenir complicações e melhorar o prognóstico.
ABSTRACT Introduction: Sarcopenia, characterized by decreased muscle mass, strength, and function, is associated with adverse clinical outcomes. However, the prevalence of sarcopenia in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and the effect of the inflammatory response on muscle strength loss in this population are unknown. We aimed to estimate the prevalence of sarcopenia on admission and its associated clinical factors in children and adolescents undergoing HSCT and to determine the extent to which the systemic inflammatory response during hospitalization affects muscle strength. Methods: Prospective cohort study of 80 patients aged 6-18 years undergoing HSCT who were followed up from May 2019 to February 2023. The outcome variables were the prevalence of sarcopenia on admission and the loss of handgrip strength (HGS) during hospitalization. The main explanatory variables were age, sarcopenia, nutritional status, and systemic inflammation as measured by serum C-reactive protein, albumin, and ferritin concentrations. Generalized estimating equations were used to analyze the association between the explanatory and outcome variables on admission and 14 days after HSCT. Results: On hospital admission, 11% of the patients had sarcopenia. Female sex, sarcopenia on admission (β coefficient 0.70; 95% CI, -1.30; -0.12; p=0.018) and serum CRP concentration (β coefficient -0.10; CI, -0.16; -0.04; p=0.001) were associated with HGS loss. Conclusion: Sarcopenia on admission and the degree of systemic inflammatory response are associated with decreased handgrip strength during hospitalization in children and adolescents undergoing HSCT. Identifying factors related to strength loss can help in early intervention to prevent complications and improve prognosis.
ABSTRACT Introduction: Sarcopenia, characterized by decreased muscle mass, strength, and function, is associated with adverse clinical outcomes. However, the prevalence of sarcopenia in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) and the effect of the inflammatory response on muscle strength loss in this population are unknown. We aimed to estimate the prevalence of sarcopenia on admission and its associated clinical factors in children and adolescents undergoing HSCT and to determine the extent to which the systemic inflammatory response during hospitalization affects muscle strength. Methods: Prospective cohort study of 80 patients aged 6-18 years undergoing HSCT who were followed up from May 2019 to February 2023. The outcome variables were the prevalence of sarcopenia on admission and the loss of handgrip strength (HGS) during hospitalization. The main explanatory variables were age, sarcopenia, nutritional status, and systemic inflammation as measured by serum C-reactive protein, albumin, and ferritin concentrations. Generalized estimating equations were used to analyze the association between the explanatory and outcome variables on admission and 14 days after HSCT. Results: On hospital admission, 11% of the patients had sarcopenia. Female sex, sarcopenia on admission (β coefficient 0.70; 95% CI, -1.30; -0.12; p=0.018) and serum CRP concentration (β coefficient -0.10; CI, -0.16; -0.04; p=0.001) were associated with HGS loss. Conclusion: Sarcopenia on admission and the degree of systemic inflammatory response are associated with decreased handgrip strength during hospitalization in children and adolescents undergoing HSCT. Identifying factors related to strength loss can help in early intervention to prevent complications and improve prognosis.