Diagnostic and prognostic value of psoas muscle thickness and area in patients with liver cirrhosis and sarcopenia

Abstract

Annotation. Sarcopenia is a typical complication of liver cirrhosis (LC) and is associated with a poor prognosis. The skeletal muscle index is the most studied radiological marker of sarcopenia, but it’s using requires the qualification of a radiologist, specialized software, time reserve. The aim of the study: to investigate the relationship between different radiological markers of skeletal muscle mass, to determine their reference ranges for Ukrainian population and to assess their diagnostic and prognostic value in patients with LC. The study involved 216 healthy people and 147 patients with LC. During 18 months of follow-up 45 patients died from LC complications. Skeletal muscles were assessed by computed tomography. Skeletal muscle index (SMI), psoas muscle index (PMI), and transverse psoas muscle thickness (TPMT) at L3 were determined. Statistical data processing was performed in SPSS22. Diagnostic and prognostic value of SMI, PMI, TPMT were studied in ROC analysis. It was found that in Ukrainian population the reference ranges of SMI are >52.2 / 39.3 cm2/m2, PMI>6. 44 / 3.49 cm2/m2, TPMT>11.1 / 7.42 mm/m, in men / women, respectively. Sarcopenia was diagnosed in 54.9% and 86.3% of LC class B and C patients. PMI and TPMT had a high diagnostic value in sarcopenia detection (SMI≤52.2 and ≤39.3 cm2/m2) in male and female LC patients (AUC PMI 0.899 and 0.955, p˂0.001, AUC TPMT 0.884 and 0.942, p˂0.001). SMI, PMI and TPMT predicted one-and-a-half-year mortality in male and female LC patients (AUC SMI 0.815 and 0.786, p<0.001; AUC PMI 0.745 and 0.804, p<0.001; AUC TPMT 0.752 and 0.871, p<0.001). The optimal cut-off values for predicting death in male and female are: SMI≤49.1 and ≤38.4 cm2/m2; PMI≤5.99 and ≤3.30 cm2/m2; TPMT≤11.0 and ≤6.70 mm/m. Thus, routine assessment of PMI and TPMT in LC can identify patients with sarcopenia and high risk of complications.