Page 199 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

RESULTS
The median neck SMI was 12 (range 8–22) and 61 patients (48%) became prolonged feeding tube dependent (see Table 1).
Sarcopenia and prolonged feeding tube dependency
Neck SMI was a significant prognostic factor for prolonged feeding tube dependency in univariable analysis, with lower SMI increasing the risk (RR 1.10; 95% CI 1.06–1.15, p < .001). The RR after adjustment for BMI, FOIS and SES was largely similar with a RR of 1.08 (95% CI 1.02–1.14, p = .013) (see Table 2). This translates to a 26% relative risk increase for prolonged feeding tube dependency per interquartile range decrease in SMI (from 14 to 11). When not adjusting for the mediating effect of BMI, the adjusted RR was 1.09 (95% CI 1.04–1.14, p = .001).
Table 2 Results of multivariable Poisson regression analysis with no prolonged (> 90 days) feeding tube dependency as outcome presented in risk ratios and p values.
Neck SMI BMI
SES
FOIS
1.08 (1.02–1.14) .013 1.01 (0.97–1.06) .634 1.08 (0.91–1.27) .378
7 1.00
<7 0.44 (0.24-0.80) .008
Sarcopenia as determinant for tube dependency
Multivariable analysis
RR (95% CI)
p value
Cut-off value for sarcopenia
The cut-off value of neck SMI in predicting prolonged feeding tube dependency with optimal sensitivity/specificity ratio was 12.7 (area under the ROC-curve 0.64, sensitivity 72%, and specificity 57%). Seventy-three patients (57%) had a neck SMI below this cut-off, indicating sarcopenia with regard to this outcome. The number of patients with a low neck SMI stratified by predicted probability on prolonged (> 90 days) feeding tube dependency according to our previously published prediction model are presented in Figure 3. The higher the predicted probability, the higher the proportion of patients with a low neck SMI. Of the 31 patients with a predicted probability below or equal to 30%, 8 (26%) had a neck SMI below the cut-off value (median SMI 13, range 9–22), compared to a 49 of the 80 patients (61%) with a predicted probability between 30-60% (median SMI 12, range 9–21), and 16 of the 17 (94%) of the patients above 60% (median SMI 11, range 8–13). All of the 16 patients who had a predicted probability above 60% and a neck SMI below the cut-off value became prolonged feeding tube dependent and all had their tubes placed either before (n = 9) or in the first four weeks of treatment (n = 7).
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