Myosteatosis for Early Detection of Muscle Disorder in Patients With Liver Cirrhosis

Abstract

Background and AimsMuscle disorders in cirrhosis is associated with poor outcome and needs early identification. Anthropometric measures lack sensitivity, and CT-based L3-skeletal muscle Index(L3-SMI) may miss early sarcopenia. The study aimed to find if SM-RA can identify more patients with muscle disorder than L3-SMI and anthropometry. Methods388 patients with cirrhosis underwent nutritional assessment by anthropometry, short-physical-performance-battery (SPPB) <9, L3-SMI (<36.5 cm2/m2 (males); <30.2 cm2/m2 (females), and myosteatosis assessment by skeletal muscle radiation attenuation (SM-RA)(<41 HU for body mass index [BMI] <24.9 kg8m2 and <33 HU for ≥25 kg/m2) and results were compared. ResultsSarcopenia based on SPPB was 38.9% with scores (9 ±1.48 vs. 10.74 ±1.25, p=0.001 in males; and 8.43 ±1.59 vs. 9.89 ±1.57, p=0.001in females). Mid-arm muscle circumference was lower in sarcopenic males [20.5 ±2.42 vs. 22.9 ±2.19 cm, p=0.001] but not in females [19.4 ± 2.73 vs. 21.1 ± 2.51, p =0.18]. L3-SMI-based sarcopenia was found in 44.8% (additional 5.92%) compared to SPPB, mostly in cryptogenic cirrhosis (19.2% vs. 35.08%, δ change +15.9%). Myosteatosis (71.64%) identified an additional 26.85% and 32.74% of patients with muscle disorder compared to L3SMI and SPPB, respectively, with the majority of new detection in non-alcoholic fatty liver disease (NAFLD) 39.4% vs. 77.06%, δ change +37.66%) CTP-A patients (16.6% vs. 36.8%, δ change +20.2%). Myosteatosis was found in 48.3% of patients with normal L3-SMI. ConclusionSM-RA can identify more patients with muscle-disorder than L3-SMI and SPPB.