Background: Non-small cell lung cancer (NSCLC) is a common and highly lethal disease. As advanced treatment modalities are being developed, improved prognostication methods are sought. L3 skeletal muscle index (L3SMI) and alanine aminotransferase (ALT) levels are accepted surrogate markers of sarcopenia and related frailty. We aimed to evaluate the potential association of these markers with NSCLC patients’ survival. Methods: A retrospective, single-center study of an NSCLC patients’ cohort. L3SMI was calculated based on skeletal muscle area on computed tomography scans at the level of the L3 vertebra. Clinical data were extracted from clinical charts. Results: A total of 140 patients (56.4% males, median age 66 [range 37–86]) were included in this study, 32% were diagnosed at stage 3 and 45% at stage 4. During the follow-up duration (median of 1.9 years; range 1 month to 6.4 years), 102 patients (72.8%) died. Patients’ characteristics that were found to be associated with increased mortality were performance status, albumin and tumor stage at diagnosis. Sarcopenia, defined as low L3SMI (lower than 41 cm^2,/m^2, for women and lower than 53 cm^2,/m^2, for men) was significantly associated with higher risk of mortality compared with patients with normal L3SMI values (77.2%, vs 64.6%, p=0.013) in univariate analysis, but not in a multiple regression analysis. Conclusion: Low L3SMI could serve as a surrogate marker for sarcopenia and frailty and, as such, facilitate the prognostication process of NSCLC patients.

Background: Sarcopenia and Frailty are syndromes that affect the clinical outcomes of patients suffering from a wide range of diseases. The use of Computed Tomography (CT) is well established for Sarcopenia evaluation via estimation of the Skeletal Muscle Index (SMI) at the level of the third lumbar vertebra (L3SMI). Nevertheless, the association of more readily available biomarkers of Sarcopenia and clinical outcomes is desired. Recent studies have associated low Alanine amino-transferase ALT (SGPT) levels with Sarcopenia and frailty. The current study aimed to establish the association between low L3SMI and the aforementioned indices of Sarcopenia, frailty and poor clinical outcomes. Methods: A cohort study of patients admitted to the internal medicine department at a tertiary medical center. Sarcopenia was determined as L3SMI, lower than 53 cm²/m² in men and 41 cm²/m² in women. Clinical and mortality data was collected from the medical record. Results: Of the 187 patients recruited (mean age 70.4 ± 9.2, 59% males), 116 (62%) had Sarcopenia, based on L3SMI values. Sarcopenic patients were older, predominantly male, had lower BMI, lower mid-arm muscle circumference (MAMC) and low ALT values upon admission. L3SMI values significantly correlated with age and MAMC among males (R = −0.38, p < 0.001, R = 0.35, p < 0.001, respectively). Sarcopenia was associated with higher, one-year mortality (HR = 2.60, 95% CI 1.06–6.37, p = 0.036) and shorter all-time survival (HR = 2.91, 95% CI 1.35–6.29, p = 0.007). The association with all-time survival remained after adjusting for age and sex (HR = 2.38, 95% CI 1.07–5.29, p = 0.034). Conclusion: As defined by low L3SMI value, Sarcopenia is a poor prognostic factor for the general internal ward patient population. As part of personalized medicine, physicians may benefit from measuring L3SMI value, as indicated by commonly performed CT scans, to objectively assess their patient’s risk of suffering from Sarcopenia and frailty-associated complications.

Data regarding the prevalence of chronic diseases and comorbidities among Adults with Congenital Heart Disease (ACHD), compared to the general population, are limited. This retrospective cohort study, comprised 11,653 ACHD patients (age>18) insured by two large healthcare providers (2007–2011). Logistic regression models were used to estimate adjusted morbidity odds ratio (OR) and the Cox proportional hazard model for estimating mortality hazard ratio (HR). Standardized Morbidity Ratios (SMR) were calculated in reference to an Israeli general population sample. Diagnosis of chronic disease or risk factor was recorded for 57.6% of patients (Age adjusted rate: 52.7%, 95% Confidence Interval (CI) 51.4–54.0). The prevalence of atherosclerotic cardiovascular disease decreased, while the prevalence of heart failure and pulmonary diseases increased with increasing ACHD complexity. Compared to the general population, ACHD patients were found to have higher morbidity rates for any disease (SMR ​= ​1.69, 95%CI: 1.64–1.74). Heart failure and atherosclerotic cardiovascular diseases were 3-times more prevalent among ACHD patients (SMR ​= ​3.19, 95%CI: 2.92–3.46, and SMR ​= ​3.58, 95%CI: 3.41–3.74, respectively), malignancies were 75% more prevalent. Diagnosis of any chronic disease was associated with increased mortality risk (HR ​= ​1.77, 95%CI: 1.51–2.06), beyond the risk associated with the congenital heart disease complexity (HR ​= ​2.37, 95% CI: 1.81–3.12). ACHD patients have excess morbidity compared to the general population. Increased mortality is attributed to both defect complexity and comorbidities, therefore, focused interventions for comorbidity prevention and management among ACHD may be required.