Abstract
Background & AimsLow muscle mass impacts on morbidity and mortality in cirrhosis. The skeletal‐muscle index (SMI) is a well‐validated tool to diagnose muscle wasting, but requires specialized radiologic software and expertise. Thus, we compared different Computed tomography (CT)‐based evaluation methods for muscle wasting and their prognostic value in cirrhosis.MethodsConsecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analysed. SMI, transversal psoas muscle thickness (TPMT), total psoas volume (TPV) and paraspinal muscle index (PSMI) were measured. Sarcopenia was defined using SMI as a reference method by applying sex‐specific cut‐offs (males: <52.4 cm2/m2; females: <38.5 cm2/m2).ResultsOne hundred and nine patients (71.6% male) of age 57 ± 11 years, MELD 16 (8‐26) and alcoholic liver disease (63.3%) as the main aetiology were included. According to established SMI cut‐offs, low muscle mass was present in 69 patients (63.3%) who also presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex‐specific cut‐offs (men/women) for diagnosing low muscle mass were determined: TPMT: <10.7/ <7.8 mm/m, TPV: <194.9/ <99.2 cm3 and PSMI <26.3/ <20.8 cm2/m2. Thirty (27.5%) patients died during a follow‐up of 15 (0.3‐45.7) months. Univariate competing risks analyses showed a significant risk for mortality according to SMI (aSHR:2.52, 95% CI: 1.03‐6.21, P = .043), TPMT (aSHR: 3.87, 95% CI: 1.4‐8.09, P = .007) and PSMI (aSHR: 2.7, 95% CI: 1.17‐6.23, P = .02), but not TPV (P = .18) derived low muscle mass cut‐offs. In multivariate analysis only TPMT (aSHR: 2.82, 95% CI: 1.20‐6.67, P = .018) was associated with mortality, SMI (aSHR: 1.93, 95% CI: 0.72‐5.16, P = .19) and PSMI (aSHR: 1.93, 95% CI: 0.79‐4.75, P = .15) were not.ConclusionLow muscle mass was highly prevalent in our cohort of patients with cirrhosis. Gender‐specific TPMT, SMI and PSMI cut‐offs for low muscle mass can help identify patients with an increased risk for mortality. Importantly, only TPMT emerged as an independent risk factor for mortality in patients with cirrhosis.
Highlights
Sarcopenia is highly prevalent in advanced chronic liver disease (ACLD) with reported prevalence rates ranging between 22% and 70%.1,2 Once sarcopenia develops, prognosis is significantly impaired and patients are at increased risk for liver‐related morbidity and mortality.[1,3,4,5,6] Based on these findings, the ‘MELD‐Sarcopenia’‐Score has been developed and has shown a higher accuracy in predicting mortality within 3 months compared to MELD alone.[7]
The skeletal‐muscle index (SMI) was reported to be an independent risk factor for mortality,[5,10] it has two main limitations: firstly, a specific software is needed to measure the cross‐sectional area of abdominal skeletal muscle, and secondly, this measurement requires the expertise of an experi‐ enced radiologist
Univariate competing risks analyses found a signifi‐ cant risk for mortality when patients were stratified according to SMI, transversal psoas muscle thickness (TPMT)‐ and paraspinal muscle index (PSMI)‐ derived low muscle mass cut‐offs (Table S1)
Summary
Sarcopenia is highly prevalent in advanced chronic liver disease (ACLD) with reported prevalence rates ranging between 22% and 70%.1,2 Once sarcopenia develops, prognosis is significantly impaired and patients are at increased risk for liver‐related morbidity and mortality.[1,3,4,5,6] Based on these findings, the ‘MELD‐Sarcopenia’‐Score has been developed and has shown a higher accuracy in predicting mortality within 3 months compared to MELD alone.[7]. According to estab‐ lished SMI cut‐offs, low muscle mass was present in 69 patients (63.3%) who presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex‐specific cut‐offs (men/women) for diagnosing low muscle mass were determined: TPMT:
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