Abstract
Background
The role of sarcopenia in predicting decompensation other than hepatic encephalopathy
is unclear. We aimed to evaluate the prognostic role of sarcopenia, assessed by computed
tomography (CT), in the development of ascites and mortality in patients with advanced
chronic liver disease (ACLD) outside the liver transplantation (LT) setting.
Material and Methods
We retrospectively evaluated ACLD patients with liver stiffness measurement (LSM)
>10 kPa and an available CT scan within 6 months. Sarcopenia was defined as skeletal
muscle index (SMI) <50 and <39 cm2/m2, respectively, in men and women. Competing risk regression models were used to assess
the variables associated with the main outcomes.
Results
209 patients were included in the final analysis and sarcopenia was present in 134
(64.1%). During a median follow-up of 37 (20–63) months, 52 patients developed ascites,
24 underwent LT, and 30 died. Sarcopenia was found a predictive factor of decompensation
with ascites (SHR 2.083, 95%-CI: 1.091–3.978), independently from the features of
clinically significant portal hypertension (LSM≥21 kPa or portosystemic shunts). Sarcopenia
(SHR: 2.744, 95%-CI: 1.105–6.816) and LSM≥21 kPa (SHR: 3.973, 95%-CI: 1.548–10.197)
were independent risk factors for increased mortality.
Conclusions
Sarcopenia and portal hypertension are two major and independent risk factors for
decompensation with ascites and mortality in cirrhotic patients outside the LT context.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients.Crit Care. 2013; 17https://doi.org/10.1186/cc12901
- Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.Lancet Oncol. 2008; 9: 629-635https://doi.org/10.1016/S1470-2045(08)70153-0
- Nutrition in patients with type 2 diabetes: present knowledge and remaining challenges.Nutrients. 2021; 13https://doi.org/10.3390/NU13082748
- Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in older people.Age Ageing. 2010; 39: 412-423https://doi.org/10.1093/AGEING/AFQ034
- EASL Clinical Practice Guidelines on nutrition in chronic liver disease.J Hepatol. 2019; 70: 172-193https://doi.org/10.1016/j.jhep.2018.06.024
- A multicenter study to define sarcopenia in patients with end-stage liver disease.Liver Transplant. 2017; 23: 625-633https://doi.org/10.1002/lt.24750
- A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort.J Hepatol. 2018; 68: 707-714https://doi.org/10.1016/j.jhep.2017.11.030
- Muscle alterations are associated with minimal and overt hepatic encephalopathy in patients with liver cirrhosis.Hepatology. 2019; 70: 1704-1713https://doi.org/10.1002/hep.30692
- Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt.Clin Transl Gastroenterol. 2019; 10https://doi.org/10.14309/ctg.0000000000000025
- Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments.J Gastroenterol. 2020; https://doi.org/10.1007/s00535-020-01711-w
- Sarcopenia predicts major complications after resection for primary hepatocellular carcinoma in compensated cirrhosis.Cancers. 2022; 14https://doi.org/10.3390/cancers14081935
- Body composition predicts mortality and decompensation in compensated cirrhosis patients: a prospective cohort study.JHEP Rep. 2020; 2100061https://doi.org/10.1016/j.jhepr.2019.11.005
- Adipopenia correlates with higher portal pressure in patients with cirrhosis.Liver Int. 2019; 39: 1672-1681https://doi.org/10.1111/liv.14175
- Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension.J Hepatol. 2015; 63: 743-752https://doi.org/10.1016/j.jhep.2015.05.022
- Baveno VII - renewing consensus in portal hypertension.J Hepatol. 2021; https://doi.org/10.1016/J.JHEP.2021.12.022
- EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis.J Hepatol. 2018; 69: 406-460https://doi.org/10.1016/j.jhep.2018.03.024
- New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm.Gut. 2018; 67: 1674-1682https://doi.org/10.1136/gutjnl-2017-315384
- Inter-operator variability and source of errors in tumour response assessment for hepatocellular carcinoma treated with sorafenib.Eur Radiol. 2018; 28: 3611-3620https://doi.org/10.1007/s00330-018-5393-3
- A combined model based on spleen stiffness measurement and Baveno VI criteria to rule out high-risk varices in advanced chronic liver disease.J Hepatol. 2018; https://doi.org/10.1016/j.jhep.2018.04.023
- Spleen stiffness measurements predict the risk of hepatic decompensation after direct-acting antivirals in HCV cirrhotic patients.Ultraschall Der Medizin - Eur J Ultrasound. 2020; https://doi.org/10.1055/a-1205-0367
- Clinical states of cirrhosis and competing risks.J Hepatol. 2018; 68: 563-576https://doi.org/10.1016/j.jhep.2017.10.020
- Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis.Clin Transl Gastroenterol. 2015; 6https://doi.org/10.1038/ctg.2015.31
- Systematic review and meta-analysis of the impact of computed tomography–assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation.Am J Transplant. 2016; 16: 2277-2292https://doi.org/10.1111/ajt.13732
- Clinical impact of sarcopenia assessment in patients with liver cirrhosis.Expert Rev Gastroenterol Hepatol. 2021; 15: 377-388https://doi.org/10.1080/17474124.2021.1848542
- Association between sarcopenia and hepatic encephalopathy: a systematic review and meta-analysis.Ann Hepatol. 2019; https://doi.org/10.1016/j.aohep.2019.06.007
- Hepatic encephalopathy and sarcopenia: two faces of the same metabolic alteration.J Clin Exp Hepatol. 2019; 9: 125-130https://doi.org/10.1016/j.jceh.2018.04.007
- Prognostic impact of sarcopenia in cirrhotic patients stratified by different severity of portal hypertension.Liver Int. 2021; 41: 799-809https://doi.org/10.1111/LIV.14758
- Identification and prognostic impact of malnutrition in a population screened for liver transplantation.Clin Nutr ESPEN. 2020; 36: 36-44https://doi.org/10.1016/j.clnesp.2020.02.013
- Adipopenia correlates with higher portal pressure in patients with cirrhosis.Liver Int. 2019; liv: 14175https://doi.org/10.1111/liv.14175
- Prevalence and impact of sarcopenia in non-cirrhotic portal hypertension.Liver Int. 2019; 39: 1937-1942https://doi.org/10.1111/liv.14160
- Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.J Hepatol. 2006; 44: 217-231https://doi.org/10.1016/j.jhep.2005.10.013
- The clinical use of HVPG measurements in chronic liver disease.Nat Rev Gastroenterol Hepatol. 2009; 6: 573-582https://doi.org/10.1038/nrgastro.2009.149
- Sarcopenia and frailty in decompensated cirrhosis.J Hepatol. 2021; 75: S147-S162https://doi.org/10.1016/j.jhep.2021.01.025
- Sarcopenia does not worsen survival in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt for refractory ascites.Am J Gastroenterol. 2020; 115: 1911-1914https://doi.org/10.14309/AJG.0000000000000959
- Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis.J Gastroenterol. 2020; 55: 217-226https://doi.org/10.1007/s00535-019-01623-4
- Continuous terlipressin infusion is associated with improved diet intake and muscle strength in patients awaiting liver transplant.JHEP Rep. 2019; 1: 107-113https://doi.org/10.1016/j.jhepr.2019.05.002
- Association between portosystemic shunts and increased complications and mortality in patients with cirrhosis.Gastroenterology. 2018; 154 (e4): 1694-1705https://doi.org/10.1053/j.gastro.2018.01.028
- Size and location of spontaneous portosystemic shunts predict the risk of decompensation in cirrhotic patients.Dig Liver Dis. 2021; https://doi.org/10.1016/j.dld.2020.12.114
- Validation of a standardized CT protocol for the evaluation of varices and porto-systemic shunts in cirrhotic patients.Eur J Radiol. 2021; 110010https://doi.org/10.1016/J.EJRAD.2021.110010
Article info
Publication history
Published online: December 03, 2022
Accepted:
November 12,
2022
Received:
September 1,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.
