Purpose: Patients with chronic limb-threatening ischemia (CLTI) often have multiple comorbidities and a poor prognosis. This study analyzes the association between the masseter muscle area (MMA), pneumonia, and the overall survival of CLTI patients older than 65 years.
Methods: The subjects of this retrospectively analysis were 54 consecutive patients with CLTI. The MMA was assessed by computed tomography (CT) as the largest cross-sectional area of the masseter muscle, located 2 cm below the zygomatic arch, at diagnosis. Pneumonia was defined as radiographic infiltrates with fever or leukocytosis, requiring hospitalization within 1 year after diagnosis. The endpoints were pneumonia incidence and survival.
Results: Pneumonia developed within 1 year in 22 patients (41%). Multivariate analysis revealed significant associations with male gender (OR: 6.24, p = 0.048), history of pneumonia (OR: 5.21, p = 0.048), and low MMA (OR: 4.46, p = 0.045). Survival rates were 72% at 1 year, 35% at 5 years, and 24% at 10 years. Low MMA was the only significant predictor of overall survival (p < 0.001).
Conclusion: The MMA was significantly associated with pneumonia and the poor prognosis of CLTI patients over the age of 65 years. As an indicator of oral frailty, the MMA may serve as a useful prognostic marker to guide treatment planning and interventions in this high-risk population.
Keywords: Chronic limb-threatening ischemia; Masseter muscle area; Oral frailty; Pneumonia.
© 2025. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.