3:45 PM Abstract No. 287 Increase in muscle mass after transjugular intrahepatic portosystemic shunt (TIPS) creation is a prognostic indicator for survival in cirrhosis

Abstract

To assess changes in skeletal muscle volume and density after TIPS creation. Patients with cirrhosis undergoing TIPS creation at a single institution between 2004 and 2015, and who had available pre- and post-TIPS contrast-enhanced CT scans, were reviewed (n = 80). Subjects who had received liver transplantation prior to TIPS creation or during the observation period (n = 4) were excluded. Cross sectional muscle area and density (psoas, paraspinal, abdominal wall) were measured with free-hand region of interest at the mid L4 vertebral body level before and after TIPS creation. Differences were compared using the paired t-test. Pairwise correlation analysis was performed to evaluate associations between baseline muscle area and clinical characteristics with post-TIPS changes. Predictors of overall survival were assessed using univariate and multivariate Cox proportional hazard models adjusted for age, sex, HCV infection, hepatocellular carcinoma, diabetes, MELD score and baseline muscle measurements. P values < 0.05 were considered significant. Significant increases in psoas, paraspinal, and total muscle areas were observed after TIPS creation (P <0.001, 0.004, 0.002). A significant increase in post-TIPS psoas muscle attenuation was also observed (3.1 ± 8.5 HU, P = 0.022). In multivariate analysis, increases in psoas (HR = 0.14, P = 0.016), paraspinal (HR = 0.15, P = 0.016), abdominal (HR = 0.05, P = 0.005), core (HR = 0.06, P = 0.001) and total (HR = 0.05, P = 0.003) muscle areas after TIPS creation predicted significantly increased survival rates compared to those with no change. Changes in core muscle area following TIPS creation were not predicted by patient demographics, comorbidities, or pre- and post-TIPS liver function studies. Cross-sectional area of truncal muscles significantly increased after TIPS creation and correlated with improved survival. These parameters can complement other determinants in the assessment of prognosis after TIPS creation. Future research will elucidate the prognostic impact of sarcopenia for TIPS creation, and will increase understanding of potential metabolic changes induced after portosystemic shunting.