Use of skeletal muscle index as a predictor of short-term mortality in patients with acute-on-chronic liver failure

Tongzeng Li,Zhongping Duan,Ming Kong,Yu Chen,Wenyan Song,Manman Xu

doi:10.1038/s41598-021-92087-1

Tongzeng Li, Zhongping Duan + Show 4 more

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https://doi.org/10.1038/s41598-021-92087-1

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Abstract

Sarcopenia is a well-recognized factor affecting the prognosis of chronic liver disease, but its impact on acute decompensation underlying chronic liver disease is unknown. This study evaluated the impact of sarcopenia on short-term mortality in patients with acute-on-chronic liver failure (ACLF). One hundred and seventy-one ACLF patients who underwent abdominal CT between 2015 and 2019 were retrospectively included in this study. Skeletal muscle index at the third lumbar vertebrae (L3-SMI) was used to diagnose sarcopenia.The ACLF patients in this study had a L3-SMI of 41.2 ± 8.3 cm2/m2 and sarcopenia was present in 95/171 (55.6%) patients. Body mass index (BMI), cirrhosis, and higher serum bilirubin were independently associated with sarcopenia. Following multivariate Cox regression analysis, cirrhosis (hazard ratio (HR) 2.758, 95%CI 1.323–5.750), serum bilirubin (HR 1.049, 95%CI 1.026–1.073), and international normalized ratio (INR) (HR 1.725, 95%CI 1.263–2.355) were associated with 3-month mortality (P < 0.05), whereas L3-SMI and sarcopenia were not. A subgroup analysis of the factors related to sarcopenia showed that sarcopenia was still not predictive of short-term outcome in ACLF patients. L3-SMI and sarcopenia are not associated with short-term mortality in patients with ACLF.

Highlights

Sarcopenia is a well-recognized factor affecting the prognosis of chronic liver disease, but its impact on acute decompensation underlying chronic liver disease is unknown
The more widely used definition of sarcopenia in patients with liver disease in Western populations comes from a multi-center cohort of patients awaiting liver transplantation, which proposed that an L3-SMI of < 50 c m2/m2 in men and < 39 c m2/ m2 in women correlates best with waitlist mortality in patients with end-stage liver disease[6]
This study aimed to explore the prognostic value of sarcopenia diagnosed with L3-SMI for predicting short-term mortality in acute-on-chronic liver failure (ACLF)

Summary

Introduction

Sarcopenia is a well-recognized factor affecting the prognosis of chronic liver disease, but its impact on acute decompensation underlying chronic liver disease is unknown. This study evaluated the impact of sarcopenia on short-term mortality in patients with acute-on-chronic liver failure (ACLF). L3-SMI and sarcopenia are not associated with short-term mortality in patients with ACLF. An increasing number of studies have used the skeletal muscle index at the third lumbar vertebrae (L3-SMI) to determine sarcopenia status in patients with liver d isease[2,3,4,5]. The evaluation criteria for sarcopenia differ, the impact of sarcopenia on adverse outcomes in patients with liver disease has been consistently recognized. In patients with cirrhosis awaiting liver transplantation (LT), sarcopenia has been shown to be a significant risk factor for waitlist mortality, postoperative complications, and post-LT d eath[8,9,10]. To the best of our knowledge, there has been no study on the impact

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