Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

Abstract

Background:
Sarcopenia appears to be associated with inferior outcomes in surgical conditions. Chronic systemic inflammation confers an inferior long-term prognosis in cardiovascular disease and is associated with the development of sarcopenia. The aim of this study was to describe the prognostic role of sarcopenia assessed using computed tomography (CT)-derived body composition analysis and systemic inflammation in patients undergoing carotid endarterectomy for symptomatic carotid stenosis.

Methods:
In this retrospective cohort study, patients undergoing carotid endarterectomy for symptomatic carotid stenosis between 1 January 2011 and 1 October 2021 at four referral centres were included. The C3 skeletal muscle index and C3 skeletal muscle density were recorded from preoperative CT images. Systemic inflammation was assessed using the preoperative systemic inflammatory grade (SIG). The primary outcome was overall mortality during the study interval.

Results:
A total of 618 patients were included, with a median follow-up of 69 (interquartile range 34–85) months. On univariable analysis, age greater than or equal to 75 years (P < 0.001), American Society of Anesthesiologists (ASA) grade greater than II (P < 0.001), low C3 skeletal muscle index (P = 0.002), low C3 skeletal muscle density (P < 0.001), SIG greater than or equal to 2 (P < 0.001), and low L3 derived skeletal muscle index (P < 0.001) were associated with increased mortality, whereas body mass index greater than or equal to 25 kg/m2 was associated with decreased mortality (P = 0.023). On multivariable analysis, age 75 years or older (HR 2.17 (95% c.i. 1.58 to 2.97), P < 0.001), ASA grade greater than II (HR 2.06 (95% c.i. 1.35 to 3.12), P < 0.001), low C3 skeletal muscle density (HR 1.84 (95% c.i. 1.33 to 2.54), P < 0.001), and SIG greater than or equal to 2 (HR 1.63 (95% c.i. 1.33 to 1.99), P < 0.001) were independently associated with increased mortality.

Conclusion:
Cervical CT-derived muscle mass and density, and markers of systemic inflammation, such as systemic inflammatory grade, may be associated with an inferior long-term prognosis after carotid endarterectomy.

People
Bradley, N.A.
Author

Bradley, Nicholas A. and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) A systematic review of the role of systemic inflammation-based prognostic scores in patients with abdominal aortic aneurysm. Surgeon, 23 (1). e1-e8. ISSN 1479-666X

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

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Dosanj, Karamonique
Author

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Chan, Sharon Yen Ming
Author

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Wilson, Alasdair
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Siddiqui, Tamim
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Bradley, Nicholas A. and Walter, Amy and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell S.D. and Guthrie, Graeme J.K. and McMillan, Donald C. (2025) The relationship between peri-operative systemic inflammation and survival in patients with abdominal aortic aneurysm. Annals of Vascular Surgery, 110 (Part A). pp. 329-339. ISSN 0890-5096

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Forsythe, Rachel
Author

Bradley, Nicholas and Dosanj, Karamonique and Chan, Sharon Yen Ming and Wilson, Alasdair and Siddiqui, Tamim and Forsythe, Rachel and Roxburgh, Campbell S.D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2024) The relationship between CT-derived cervical muscle mass and quality, systemic inflammation, and survival in symptomatic patients undergoing carotid endarterectomy. BJS Open, 8 (5): zrae114. ISSN 2474-9842

See full publications list
Roxburgh, Campbell S. D.
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Thompson, Joshua J. and MacLeod, Nicholas and Will, Sarah and O'Rourke, Fraser and McGovern, Josh and Roxburgh, Campbell and Edwards, Joanne and Dolan, Ross D. and McMillan, Donald C. (2025) The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer. BMC Cancer, 25: 543. ISSN 1471-2407

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

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McMillan, D.C.
Author

Bradley, Nicholas A. and Walter, Amy and Sankey, Chiara and Wilson, Alasdair and Siddiqui, Tamim and Roxburgh, Campbell D. and McMillan, Donald C. and Guthrie, Graeme J.K. (2025) Longitudinal association between statins and changes in CT derived body composition in patients with abdominal aortic aneurysm. Journal of Cachexia, Sarcopenia and Muscle, 16 (2). ISSN 2190-5991

Thompson, Joshua J. and MacLeod, Nicholas and Will, Sarah and O'Rourke, Fraser and McGovern, Josh and Roxburgh, Campbell and Edwards, Joanne and Dolan, Ross D. and McMillan, Donald C. (2025) The prognostic value of a laboratory cachexia score (LCAS) defined by LDH, CRP and albumin in patients with advanced lung cancer. BMC Cancer, 25: 543. ISSN 1471-2407

Dolan, Ross D. and Pennel, Kathryn and Thompson, Joshua and McKenzie, Molly and Alexander, Peter and Richards, Colin and Black, Douglas and Abbass, Tanvir and Maka, Noori and McGovern, Josh and Roseweir, Antonia and McSorley, Stephen T. and Horgan, Paul G. and Roxburgh, Campbell and McMillan, Donald C. and Edwards, Joanne (2025) The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer. BJC Reports, 3 (1): 7. ISSN 2731-9377

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