P: 25 Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis

Abstract

BACKGROUND: Muscle alterations (myosteatosis and sarcopenia) are frequent in cirrhosis and related to some complications included overt hepatic encephalopathy. The aim of our study was to investigate the relationship between muscle alterations and minimal hepatic encephalopathy (MHE) and their role on the risk of overt HE. METHODS: 64 cirrhotics were submitted to Psychometric Hepatic Encephalopathy Score (PHES) and to Animal Naming Test (ANT) to detect MHE. CT scan was used to analyse the skeletal muscle index (SMI) and attenuation. The incidence of the first episode of HE, taking into account the competing risk nature of the data, was estimated. RESULTS: Myosteatosis was observed in 24 patients (37.5%), sarcopenia in 37 (58%) and MHE in 32 (50%). Both myosteatosis (62.5 vs 12.5%; P < 0.001) and sarcopenia (84 vs 31%; P < 0.001) were more frequent in patients with MHE. The variables independently associated to the presence of MHE were: sarcopenia, previous overt HE and myosteatosis. Thirty-one (48%) patients developed overt HE during 16.1 ± 13 months; myosteatosis was detected in 68% and sarcopenia in 84% of them. Sarcopenia and myosteatosis were also independently associated to the development of overt HE. Venous ammonia was significantly higher in sarcopenic patients (62.6 ± 17.7 vs 41.4 ± 16.1 μg/dl; P < 0.001) and in myosteatosic patients (65.2 ± 19.2 vs 46.7 ± 17.1 μg/dl; P < 0.001) and inversely correlated to both parameters. Survival was significantly lower in malnourished patients compared with patients without myosteatosis or sarcopenia (P < 0.001). CONCLUSIONS: Myosteatosis and sarcopenia, probably by reducing the handling of ammonia in the muscle, are independently associated to MHE and to the risk of overt HE in cirrhotics. In malnourished patients, the amelioration of nutritional status may be a possible goal to decrease both the prevalence oh MHE and the incidence of overt HE.