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COVID-19 Information for Clinicians in UpToDate®

·         Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention

·         Coronavirus disease 2019 (COVID-19): Management in adults

·         Coronavirus disease 2019 (COVID-19): Infection control in health care and home settings

·         Coronavirus disease 2019 (COVID-19): Airway management, anesthesia machine ventilation, and anesthetic care

·         Coronavirus disease 2019 (COVID-19): Critical care issues

·         Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease

·         Coronavirus disease 2019 (COVID-19): Coronary artery disease issues

·         Coronavirus disease 2019 (COVID-19): Myocardial injury

·         Coronavirus disease 2019 (COVID-19): Issues related to kidney disease and hypertension

·         Coronavirus disease 2019 (COVID-19): Pregnancy issues

·         Coronavirus disease 2019 (COVID-19): Considerations in children

·         Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic

·         Coronavirus disease 2019 (COVID-19): Psychiatric issues

Additional Clinical Topics

·         Acute respiratory distress syndrome: Clinical features, diagnosis, and complications in adults

·         Ventilator management strategies for adults with acute respiratory distress syndrome

·         Prone ventilation for adult patients with acute respiratory distress syndrome

·         Extracorporeal membrane oxygenation (ECMO) in adults

Society Guidelines

·         Society guideline links: Coronavirus disease 2019 (COVID-19) – International and government guidelines for general care

·         Society guideline links: Coronavirus disease 2019 (COVID-19) – Guidelines for specialty care

·         Society guideline links: Coronavirus disease 2019 (COVID-19) – Resources for patients

COVID-19 Patient Education

·         Patient education: Coronavirus disease 2019 (COVID-19) overview (The Basics)

·         Patient education: Coronavirus disease 2019 (COVID-19) and children (The Basics)

·         Patient education: Coronavirus disease 2019 (COVID-19) and pregnancy (The Basics)

·         Patient education: Acute respiratory distress syndrome (The Basics)

Questions and Answers

·         Coronavirus disease 2019 (COVID-19): Questions and answers

·         Coronavirus disease 2019 (COVID-19) and pregnancy: Questions and answers

In Lexicomp® Clinical Drug Information

·         Coronavirus Disease (COVID019) Discharge Instructions (PDF)

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·         Lexi Pharmacogenomics

 

Wolters Kluwer Coronavirus Resources & Tools page provides resources across our Health solutions.

CCC publication: Treatment Outcomes of Incidental Intracranial Meningiomas: Results from the IMPACT Cohort

Citation: World Neurosurgery. 2020, 138, e725-e735. Epub 2020 Mar 19
Author: Islim AI, Mohan M, Moon RDC, Rathi N, Kolamunnage-Dona R, Crofton A, Haylock BJ, Mills SJ, Brodbelt AR, Jenkinson MD
Abstract: BACKGROUND: Incidental findings such as meningioma are becoming increasingly prevalent. There is no consensus on the optimal management of these patients. The aim of this study was to examine the outcomes of patients diagnosed with an incidental meningioma who were treated with surgery or radiotherapy.
METHODS: Single-center retrospective cohort study of adult patients diagnosed with an incidental intracranial meningioma (2007-2015). Outcomes recorded were postintervention morbidity, histopathologic diagnosis, and treatment response.
RESULTS: Out of 441 patients, 44 underwent treatment. Median age at intervention was 56.1 years (interquartile range [IQR], 49.6-66.5); patients included 35 women and 9 men. The main indication for imaging was headache (25.9%). Median meningioma volume was 4.55 cm3 (IQR, 1.91-8.61), and the commonest location was convexity (47.7%). Six patients underwent surgery at initial diagnosis. Thirty-eight had intervention (34 with surgery and 4 with radiotherapy) after a median active monitoring duration of 24 months (IQR, 11.8-42.0). Indications for treatment were radiologic progression (n = 26), symptom development (n = 6), and patient preference (n = 12). Pathology revealed World Health Organization (WHO) grade 1 meningioma in 36 patients and WHO grade 2 in 4 patients. The risk of postoperative surgical and medical morbidity requiring treatment was 25%. Early and late moderate adverse events limiting activities of daily living occurred in 28.6% of patients treated with radiotherapy. Recurrence rate after surgery was 2.5%. All meningiomas regressed or remained radiologically stable after radiotherapy.
CONCLUSIONS: The morbidity after treatment of incidental intracranial meningioma is not negligible. Considering most operated tumors are WHO grade 1, treatment should be reserved for those manifesting symptoms or demonstrating substantial growth on radiologic surveillance.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS: Asymptomatic; Incidental; Meningioma; Radiotherapy; Surgery


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CCC publication: Brentuximab Vedotin for Treating Relapsed or Refractory CD30-Positive Cutaneous T-Cell Lymphoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

Citation: PharmacoEconomics Open. 2020, 4(4) 563-74. 2020 Mar 23 [Epub ahead of print]
Author: Stainthorpe A, Fleeman N, Houten R, Chaplin M, Boland A, Beale S, Dundar Y, McEntee J, Syndikus I
Abstract: As part of the single technology appraisal process, the National Institute for Health and Care Excellence invited Takeda UK Ltd to submit clinical- and cost-effectiveness evidence for brentuximab vedotin (BV) for treating relapsed or refractory CD30-positive (CD30+) cutaneous T-cell lymphoma (CTCL). The Liverpool Reviews and Implementation Group at the University of Liverpool was commissioned to act as the evidence review group (ERG). This article summarises the ERG's review of the company's submission for BV and the appraisal committee (AC) decision. The principal clinical evidence was derived from a subgroup of patients with advanced-stage CD30+ mycosis fungoides (MF) or primary cutaneous anaplastic large-cell lymphoma (pcALCL) in the phase III ALCANZA randomised controlled trial (RCT). This trial compared BV versus physician's choice (PC) of methotrexate or bexarotene. Evidence from three observational studies was also presented, which included patients with other CTCL subtypes. The ERG's main concerns with the clinical evidence were the lack of RCT evidence for CTCL subtypes other than MF or pcALCL, lack of robust overall survival data (data were immature and confounded by subsequent treatment and treatment crossover on disease progression) and lack of conclusive results from analyses of health-related quality-of-life data. The ERG noted that many areas of uncertainty in the cost-effectiveness analysis were related to the clinical data, arising from the rarity of the condition and its subtypes and the complexity of the treatment pathway. The ERG highlighted that the inclusion of allogeneic stem-cell transplant (alloSCT) as an option in the treatment pathway was based on weak evidence and generated more uncertainty in a disease area that, because of its rarity and diversity, was already highly uncertain. The ERG also lacked confidence in the company's modelling of the post-progression pathway and was concerned that it may not produce reliable results. Results from the company's base-case comparison (including a simple discount patient access scheme [PAS] for BV) showed that treatment with BV dominated PC. The ERG's revisions and scenario analyses highlighted the high level of uncertainty around the company base-case cost-effectiveness results, ranging from BV dominating PC to an incremental cost-effectiveness ratio per quality-adjusted life-year gained of £494,981. The AC concluded that it was appropriate to include alloSCT in the treatment pathway even though data were limited. The AC recommended BV as an option for treating CD30+ CTCL after at least one systemic therapy in adults if they have MF, stage IIB or higher pcALCL or Sézary syndrome and if the company provides BV according to the commercial arrangement (i.e. simple discount PAS).


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CCC publication: Quality of life with second or third line nab-paclitaxel-based regimens in advanced non-small-cell lung cancer

Citation: Future Oncology. 2020, 16(12), 749-62 Epub 2020 Mar 31
Author: Ponce Aix S, Talbot D, Govindan R, Dols MC, Postmus PE, Lewanski C, Bennouna J, Fischer JR, Juan-Vidal O, Stewart DJ, Ardizzoni A, Bhore R, Wolfsteiner M, Reck M, Ong TJ, Morgensztern D
Abstract: Aim: Evaluate quality of life (QoL) in patients with advanced non-small cell lung cancer treated with second or third line nab-paclitaxel ± durvalumab. Patients & methods: Longitudinal QoL was assessed using Lung Cancer Symptom Scale, EuroQoL Five-Dimensions Five-Levels and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core. Results: QoL was generally stable through eight treatment cycles (both arms). Clinically meaningful improvement from baseline was noted in Lung Cancer Symptom Scale (overall constitutional score and three-item index [nab-paclitaxel + durvalumab]) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (global health status/QoL and emotional functioning [both arms] and pain [nab-paclitaxel + durvalumab]) analyses. EuroQoL Five-Dimensions Five-Levels domains were stable/improved or completely resolved at least once in 19-56% and 9-51% of patients, respectively. Conclusion: While QoL trends were promising, additional data are required to support these regimens in this setting.
KEYWORDS: EORTC QLQ-C30; EQ-5D-5L; durvalumab; lung cancer symptom scale; nab-paclitaxel; non-small cell lung cancer; quality of life


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CCC publication: Prostate Cancer Radiotherapy Recommendations in Response to COVID-19

Citation: Advances in radiation oncology. 2020 Apr 1 [Epub ahead of print]
Author: Zaorsky NG, Yu JB, McBride SM, Dess RT, Jackson WC, Mahal BA5, Chen R, Choudhury A, Henry A, Syndikus I, Mitin T, Tree A, Kishan AU, Spratt DE
Abstract: Purpose: During a global pandemic the benefit of routine visits and treatment of cancer patients must be weighed against the risks to patients, staff, and society. Prostate cancer is one of the most common cancers Radiation Oncology departments treat, and efficient resource utilization is essential in the setting of a pandemic. Herein, we aim to establish recommendations and a framework by which to evaluate prostate radiotherapy management decisions.
Patients and Methods: Radiation Oncologists from the United States and United Kingdom rapidly conducted a systematic review and agreed upon recommendations to safely manage prostate cancer patients during the COVID-19 pandemic. A RADS framework was created: Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy was applied to determine appropriate approaches.
Results: Recommendations are provided by National Comprehensive Cancer Network (NCCN) risk group, including clinical node positive, post-prostatectomy, oligometastatic, and low volume M1 disease. Across all prostate cancer stages, telemedicine consultations and return visits were recommended when resources/staff available. Delays in consultations and return visits was deemed safe based on stage of disease between 1-6 months. Treatment can be avoided or delayed until safe for very low, low, and favorable intermediate-risk disease. Unfavorable intermediate-risk, high-risk, clinical node positive, recurrence post-surgery, oligometastatic, and low-volume M1 disease can receive neoadjuvant hormone therapy for 4-6 months as necessary. Ultrahypofractionation was preferred for localized, oligometastatic, and low volume M1, and moderate hypofractionation was preferred for post-prostatectomy and clinical node positive disease. Salvage was preferred to adjuvant radiation.
Conclusion: Resources can be reduced for all identified stages of prostate cancer. The RADS (Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy) framework can be applied to other disease sites to help with decision making in a global pandemic.
© 2020 The Author(s).
KEYWORDS: Coronavirus; prostate cancer; radiation oncology; radiotherapy


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CCC publication: Comparing Proton to Photon Radiotherapy Plans: UK Consensus Guidance for Reporting Under Uncertainty for Clinical Trials

Citation: Clinical Oncology. 2020, 32(7), 459-66. Epub 2020 Apr 16
Author: Lowe, Gosling, Nicholas, Underwood, Miles, Chang, Amos, Burnet, Clark, Patel, Tsang, Sisson, Gulliford
Abstract: In the UK, the recent introduction of high-energy proton beam therapy into national clinical practice provides an opportunity for new clinical trials, particularly those comparing proton and photon treatments. However, comparing these different modalities can present many challenges. Although protons may confer an advantage in terms of reduced normal tissue dose, they can also be more sensitive to uncertainty. Uncertainty analysis is fundamental in ensuring that proton plans are both safe and effective in the event of unavoidable discrepancies, such as variations in patient setup and proton beam range. Methods of evaluating and mitigating the effect of these uncertainties can differ from those approaches established for photon therapy treatments, such as the use of expansion margins to assure safety. These differences should be considered when comparing protons and photons. An overview of the effect of uncertainties on proton plans is presented together with an introduction to some of the concepts and terms that should become familiar to those involved in proton therapy trials. This report aims to provide guidance for those engaged in UK clinical trials comparing protons and photons. This guidance is intended to take a pragmatic approach considering the tools that are available to practising centres and represents a consensus across multidisciplinary groups involved in proton therapy in the UK.
Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
KEYWORDS: Clinical trials; guidelines; proton therapy; proton therapy comparison; uncertainty


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CCC publication: Effect of Baseline Characteristics on Cabazitaxel Treatment Duration in Patients with Metastatic Castration-Resistant Prostate Cancer: A Post Hoc Analysis of the Compassionate Use/Expanded Access Programs and CAPRISTANA Registry

Citation: Cancers. 2020, 12(4), E995
Author: Malik, Di Lorenzo, Pichler, De Giorgi, Hitier, Ecstein-Fraisse, Ozatilgan, Carles
Abstract: We examined factors that may impact cabazitaxel treatment duration in a real-life setting in a compassionate use program, expanded access program, and prospective observational study in metastatic castration-resistant prostate cancer (mCRPC). Patients with mCRPC previously treated with docetaxel (N = 1,621) received cabazitaxel 25 mg/m2 intravenously every 3 weeks until disease progression, death, unacceptable toxicity or physician/patient decision. The median number of cabazitaxel cycles was six (range, 1-49); 708 patients (43.7%) received >6 cycles. Patients receiving >6 cycles tended to have a better Eastern Cooperative Oncology Group performance status of 0-1 (p = 0.0017 for ≤6 vs. >6 cycles). Overall, 348 patients (21.5%) were ≥75 years of age; 139 (39.9%) received >6 cycles. The main reason for discontinuation was disease progression; however, in patients receiving 1-2 cycles, the main reason for discontinuation was adverse events. Only 52 patients (3.2%) progressed during cycles 1-2. Cabazitaxel was well tolerated in these studies, which included some elderly and frail patients, offering clinicians an important treatment option in the management of mCRPC. Proactive management of adverse events may allow patients to receive a higher number of cabazitaxel cycles and derive greater benefit.
KEYWORDS: CAPRISTANA; CUP; EAP; cabazitaxel; mCRPC; real-world


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WUTH publication: Omitting Cortical Renorrhaphy in Robotic Assisted Partial Nephrectomy: Is it safe? A single centre large case series

Citation: Journal of Endourology. 2020 Apr 22 [Epub ahead of print]
Author: Alrishan Alzouebi I, Williams A, Thiarajan NR, Kumar M
Abstract: INTRODUCTION: Preserving renal function after Robotic Assisted Partial Nephrectomy is important and influenced by the technique of renal reconstruction amongst other parameters including ischaemia time and amount of healthy renal tissue resected. It is believed that reconstruction with a second layer of cortical renorrhaphy is necessary to prevent urinary leaks and post-operative bleeding but this is associated with the potential loss of healthy renal parenchyma and may result in worse outcomes post-operatively.
PURPOSE: To assess the safety of omitting cortical renorrhaphy during RAPN .
PATIENTS AND METHODS: A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy with single or double layer renorrhaphy at the Wirral University Teaching Hospital from 2014-2019. Data obtained included: Patient demographics, tumour RENAL Nephrometry, Peri-operative parameters; blood loss, duration and warm ischaemia time, Post-op complications, change in eGFR (pre and 3 months post-op), length of stay and oncological outcomes.
RESULTS: In total 146 patients were identified. 106 had double renorrhaphy and 40 inner layer only renorrhaphy. No significant differences were seen between these two cohorts in terms of patient demographics, RENAL Nephrometry score, tumour size or location. Peri-operative parameters showed a reduced duration of surgery in the single renorrhaphy group with a mean of 125 minutes compared to143 minutes in the double renorrhaphy(p 0.006) and a tendency towards a shorter WIT of 12.9 minutes versus 14.0 minutes reaching borderline statistical significance (p 0.05) but no difference in blood loss volume (p 0.25). Post-operatively there was no statistical difference in the length of hospital stay (p 0.85), loss in eGFR at 3 months (0.06) or complication (p 0.56). After a median follow up of 35 months no recurrences or deaths were observed in either group. Conclusions Omission of cortical renorrhaphy appears feasible and safe with no urine leaks or excess complications observed.


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WUTH publication: Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial

Citation: BMJ Open. 2020, 10(4), e035516
Author: Noble AJ, Snape D, Nevitt S, Holmes EA, Morgan M, Tudur-Smith C, Hughes DA, Buchanan M, McVicar J, MacCallum E, Goodacre S, Ridsdale L, Marson AG
Abstract: OBJECTIVE: To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE).
DESIGN: Pilot RCT with embedded microcosting.
SETTING: Three English hospital emergency departments (EDs).
PARTICIPANTS: Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs).
INTERVENTIONS: Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course.
MAIN OUTCOME MEASURES: Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost.
RESULTS: Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months.
CONCLUSIONS: In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population.
TRIAL REGISTRATION NUMBER:
ISRCTN13871327.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
KEYWORDS: accident & emergency medicine; clinical trials; epilepsy; health economics; organisation of health services


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Oxford Medicine Online Access to assist with tackling COVID-19

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WUTH publication: Being a max-fax DCT

Citation: British Dental Journal. 2020, 228(7), 493-94
Author: Loh M


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WUTH publication: Complexes between C-Reactive Protein and Very Low Density Lipoprotein Delay Bacterial Clearance in Sepsis

Citation: Journal of Immunology. 2020 Apr 8 [Epub ahead of print]
Author: Cheng Z, Abrams ST, Toh J, Wang SS, Downey C, Ge X, Yu Q, Yu W, Wang G, Toh CH
Abstract: C-reactive protein (CRP) can increase up to 1000-fold in blood and form complexes with very low density lipoproteins (VLDL). These complexes are associated with worse outcomes for septic patients, and this suggests a potential pathological role in sepsis. Complex formation is heightened when CRP is over 200 mg/l and levels are associated with the severity of sepsis and blood bacterial culture positivity. Using a mouse bacteremia model, blood bacterial clearance can be delayed by i.v. injection of CRP-VLDL complexes. Complexes are more efficiently taken up by activated U937 cells in vitro and Kupffer cells in vivo than VLDL alone. Both in vitro-generated and naturally occurring CRP-VLDL complexes reduce phagocytosis of bacteria by activated U937 cells. Fcγ and scavenger receptors are involved and a competitive mechanism for clearance of CRP-VLDL complexes and bacteria is demonstrated. Interaction of phosphocholine groups on VLDL with CRP is the major driver for complex formation and phosphocholine can disrupt the complexes to reverse their inhibitory effects on phagocytosis and bacterial clearance. Increased formation of CRP-VLDL complexes is therefore harmful and could be a novel target for therapy in sepsis.


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WUTH publication: Comparative effectiveness and safety of direct-acting oral anticoagulants (DOACS) for the reduction of recurrent venous thromboembolism in cancer patients: A protocol for systematic review and network meta-analysis using a generalized pairwise modeling methodology

Citation: Medicine (Baltimore). 2020, 99(14), e19679
Author: Danjuma MI, Mohamed MFH, ElShafei MN, Fatima H, Shokri SA, Mohamed S, Abubeker IY, Kartha A, Elzouki AN, Mohamedali MGH, Mahgboub Y, Bidmos M
Abstract: BACKGROUND: There has been a significant improvement in both our understanding and therapeutic choices available to clinicians for the management of cancer associated thrombosis (CAT). Even with the recent publication of a systematic review and landmark trials demonstrating the non-inferiority of DOACS-based anticoagulation strategy compared to the standard of care in patients with CAT, there is unresolved uncertainty regarding the exact hierarchy of risks and effectiveness of various DOAC analogues in these cohorts of patients.
METHOD: We will carry out a network meta-analyses, utilizing a novel generalized pairwise methodology to generate direct and indirect comparisons between the various DOAC analogues. We will search the following databases for studies that satisfies pre-specified inclusions criteria; these include PubMed, EMBASE, Cochrane library, Clinicaltrials.gov, conference abstracts among other sources. The primary efficacy and safety outcomes are recurrent VTE and major hemorrhagic events, respectively. Two reviewers will Search the databases independently with the view to identify studies that meet eligibility criteria. The methodological quality of the included studies will be determined using a recently validated risk of bias assessment tool.
RESULTS: We expect that the result of this review will ascertain the hierarchy of risks and effectiveness of various DOAC analogues in patients with CAT.
CONCLUSION: Results of this review will assist in informed decisions making regarding therapeutic guidelines of DOAC in CAT.


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WUTH publication: Measuring sarcopenia on pre-operative CT in older adults undergoing emergency laparotomy: a comparison of three different calculations

Citation: International Journal of Colorectal Disease. 2020 Mar 25 [Epub ahead of print]
Author: Simpson G, Manu N, Magee C, Wilson J, Moug S, Vimalachandran D
Abstract: INTRODUCTION: Sarcopenia is associated with outcomes in older-adults undergoing emergency surgery. Psoas major measurement is a surrogate marker of sarcopenia with multiple calculations existing normalising to body size and no consensus as to which is optimal. We compared three different psoas-major calculations to predict outcomes in older adults undergoing emergency laparotomy.
METHODS: Consecutive over 65s were identified from the National Emergency Laparotomy Audit(NELA) database at a single centre between 2014 and 2018. Psoas major was measured at the L3 level and normalised to height (psoas muscle index, PMI), L3 vertebral body (psoas muscle:L3 ratio, PML3) or body surface area (psoas:body surface area, PBSA) and each correlated to outcomes. Outcome measures included inpatient, 30-day and 90-day mortality. A comparison of the three calculations was performed using the Mann-Whitney U, chi-squared, receiver operating characteristic curves (ROC) and binary logistic regression.
RESULTS: Two hundred and sixty-four older adults underwent emergency laparotomy (median age, 75 years ((IQR, 70-81 years), 50% female)). Inpatient mortality was 19.6%, 30-day mortality was 15.1% and 90-day mortality was 18.5%. A total of 31.1% of males and 30% of females were sarcopenic (30.6% overall). A multivariate analysis confirmed each method of psoas major calculation (p < 0.0001) to be associated with mortality, as was ASA-grade (p < 0.0001). Area under the curve (AUC) was greatest for PML3 in predicting mortality (inpatient: PML3, 0.76; PMI, 0.71; PBSA, 0.70; 30-day: PML3, 0.74; PMI, 0.68; PBSA, 0.68; and 90-day: PML3, 0.78; PMI, 0.71; PBSA, 0.70). ASA-grade, P-POSSUM and PML3 were independently associated with mortality on multivariate analysis. ROC analysis of predictions from logistic regression models demonstrated PML3 to be more closely aligned to mortality than ASA or P-POSSUM (inpatient: AUC:PML3, 0.807; ASA, 0.783; P-POSSUM, 0.762; 30-day:AUC: PML3, 0.799; ASA, 0.784; P-POSSUM, 0.787; and 90-day: AUC:PML3, 0.805; ASA, 0.781; P-POSSUM, 0.756).
CONCLUSIONS: Sarcopenia was present in 30.6% of older adults undergoing emergency surgery and is associated with a significantly increased mortality. PML3 is superior to PMI or PBSA and should be considered the method of calculation of choice. Additionally, PML3 compares favourably to ASA and P-POSSUM.
KEYWORDS: Emergency laparotomy; Muscle-mass; Psoas major; Sarcopenia


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