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Improvement of sarcopenia is beneficial for prognosis in cirrhotic patients after TIPS placement

  • Author Footnotes
    1 These authors contributed equally to this work.
    Jiacheng Liu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Chongtu Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Jinghong Yao
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yaowei Bai
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
    Search for articles by this author
  • Tongqiang Li
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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  • Yingliang Wang
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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  • Qin Shi
    Affiliations
    Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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  • Xiaomei Wu
    Affiliations
    Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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  • Jinqiang Ma
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
    Search for articles by this author
  • Chen Zhou
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
    Search for articles by this author
  • Songjiang Huang
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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  • Bin Xiong
    Correspondence
    Corresponding author at: Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China.
    Affiliations
    Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China

    Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:January 20, 2023DOI:https://doi.org/10.1016/j.dld.2023.01.001

      Abstract

      Background

      The relationship between the improvement of sarcopenia and post-TIPS prognosis has not been fully investigated.

      Aims

      To assess what level of sarcopenia improvement is required for potential benefits to post-TIPS prognosis.

      Methods

      In this retrospective study, 109 cirrhotic patients with sarcopenia who underwent TIPS between February 2016 and January 2021 were included. The change in skeletal muscle index (SMI) at 6 months post-TIPS was assessed and the correlations of SMI improvement with clinical outcomes were analyzed.

      Results

      During follow up, 59 (65.6%) patients reversed from sarcopenic to non-sarcopenic, and the cumulative mortality (8.5 % vs. 26.0%, log rank P = 0.013) and incidence of overt hepatic encephalopathy (OHE) (18.6% vs. 44.0%, log rank P = 0.004) in patients who reversed were significantly lower than who did not. SMI improvement rate was identified as an independent risk factor for mortality and OHE. In addition, the cumulative survival rate of patients with sarcopenia reversal or SMI improvement rate > 10.4% was significantly higher than that of patients with an SMI improvement rate ≤ 10.4% (92.5% vs. 58.6%, log rank P < 0.001).

      Conclusion

      Reversal of sarcopenia or significant SMI improvement by TIPS could reduce the risk of death and OHE.

      Keywords

      Abbreviations:

      AUC (area under the curve), BIA (bioelectrical impedance analysis), BMI (body mass index), CI (confidence interval), DEXA (dual-energy X-ray absorptiometry), EASL (European Association for the Study of the Liver), HE (hepatic encephalopathy), HR (hazard ratio), HU (Hounsfield unit), MELD (model for end-stage liver disease), PPG (portal pressure gradient), ROC (receiver operating characteristics), SMA (skeletal muscle area), SMI (skeletal muscle index), TIPS (transjugular intrahepatic portosystemic shunt)
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