Psoas Muscle Index Can Be Used to Predict Long-Term Mortality in Young Male Patients With Acute-on-Chronic Liver Failure.

Manman Xu,Wenyan Song,Zhongping Duan,Guanya Guo,Yu Chen,Ying Han,Nan Geng,Ming Kong,Tongzeng Li

doi:10.3389/fnut.2022.811826

Abstract

ObjectiveThe use of psoas muscle index (PMI) in acute-on-chronic liver failure (ACLF) has not been reported, and the aim of this study was to evaluate the predictive value of PMI for the prognosis of patients with ACLF.MethodsIn this study, male ACLF patients who underwent abdominal CT between 2015 and 2019 in our center were included to analyze the association between PMI and 1-year mortality in male ACLF patients, and subgroup analyses were performed according to age stratification (≤ 40 and >40 years).ResultsWe included 116 male patients with confirmed ACLF, with a mean PMI of 5.98 ± 1.68 cm2/m2 and a 1-year mortality of 51.7% (60). Univariate COX regression analysis showed that PMI was a protective factor [hazard ratio (HR), 0.851, 95%CI: 0.734–0.987] for 1-year mortality in male patients with ACLF. Nevertheless, multivariate analysis did not find an independent relationship between PMI and 1-year mortality. Subgroup analysis by age found that adjusted for MELD score, PMI was independently associated with 1-year mortality in young (age ≤ 40 years) male patients with ACLF (HR 0.689, 95% CI: 0.496–0.958). While no effect of PMI on 1-year mortality in non-young (age > 40 years) male ACLF patients was found. Correlation analysis found that there was no significant correlation between PMI and age in young (age ≤ 40 years) male ACLF patients, but, PMI decreased with age (r = −0.246, P < 0.05) in non-young (age > 40 years) male ACLF patients.ConclusionPMI was found to be associated with 1-year mortality in male ACLF patients, especially in patients younger than 40 years, PMI predict 1-year mortality independent of MELD score.

Highlights

The evaluation of nutritional status of patients with chronic liver disease by muscle mass and muscle function is receiving more and more attention
Of the 116 male Acute-on-chronic liver failure (ACLF) patients, 60 (51.7%) patients were alive at 360 days, 51 patients died and 5 underwent liver transplantation
The mean age of patients in the male ACLF survival group was 40.88 ± 10.46 years, which was significantly lower than that of the non-survival group (46.55 ± 9.66 years) (P = 0.003); The proportion of cirrhotic patients in the non-survival group (79%) was significantly higher than that in the survival group (45%), and the difference was statistically significant.Total bilirubin, INR, Model End-Stage Liver Disease (MELD) score were significantly higher and serum sodium level was significantly (P < 0.05) lower in the non-survival group compared to the survival group

Summary

Introduction

The evaluation of nutritional status of patients with chronic liver disease by muscle mass and muscle function is receiving more and more attention. Numerous studies [2–5] have used the skeletal muscle index at the third lumbar vertebrae (L3SMI) to determine sarcopenia, to further evaluate the association between sarcopenia and the prognosis of patients with chronic liver disease (CLD), and some studies have evaluated the impact of the psoas muscle index (PMI) on the prognosis of CLD [6, 7]. Studies [8–11] have shown that sarcopenia can be valuable as a predictor of disease progression, complications of cirrhosis such as the incidence of hepatic encephalopathy, mortality of cirrhotic patients, long-term outcome after liver transplantation, and outcome of patients with HCC. Study [14] has shown that PMI is positively correlated with L3-SMI and is able to predict long-term prognosis in patients with cirrhosis [6]

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Conclusion