Radiological psoas muscle parameters as a reliable tool for detection of sarcopenia and prediction of short-term survival in liver cirrhosis

Abstract

Loss of skeletal muscle mass or sarcopenia is associated with the development of complications and mortality in patients with liver cirrhosis (LC). Skeletal muscle index (SMI) is the most validated parameter of sarcopenia in clinical studies, but its evaluation is difficult in routine clinical practice. The purpose of the study was to assess the diagnostic concordance between different radiologic skeletal muscle parameters and their relationship with a short-term survival of LC patients. The study involved 147 LC patients, including 90 males and 57 females (55.51±0.97). LC Class A according to Child-Turcotte-Pugh (CTP) was diagnosed in 23 patients, class B in 51 patients, and class C in 73 patients. 50 patients died from LC complications during the follow-up period (489 (306 – 637) days). Skeletal muscle index (SMI), psoas muscle mass index (PMI), and transversal psoas muscle thickness (TPMT) were calculated using the computed tomography at L3 level. The statistical data was processed using the SPSS22 software (© SPSS Inc.). PMI and TPMT were found to be objective parameters of sarcopenia in LC patients having stable diagnostic concordance with SMI (r Spearman’s 0.734, 0.649, p˂0.001; k Cohen’s 0.727, 0.643, p˂0.001, respectively). The use of all three parameters allowed to reveal more patients with a reduced skeletal muscle mass. Sarcopenia was diagnosed in 54.9 % of CTP B patients, 86.3 % of CTP C patients, and was associated with an elevated incidence of ascites, hydrothorax, hepatic encephalopathy, and hypoalbuminemia. Sarcopenic patients were found more likely to have an alcohol-related etiology than viral one (HBV, HCV). The overall survival of patients with low SMI, PMI and TPMT was significantly lower according to Kaplan-Meier analysis. SMI, PMI, and TPMT were independent predictors of LC-associated mortality (HR 2.66, 2.19, 2.21, respectively, p˂0.05) in Cox proportional hazards regression. At least one of the three decreased radiologic skeletal muscle mass parameters was associated with the highest risk of fatal LC complications (HR 3.65, p=0.021). Therefore, the psoas muscle dimensions were considered a reliable tool for detection of sarcopenia and prediction of short-term survival in LC.