A Sex‐Stratified Prognostic Nomogram Incorporating Body Compositions for Long‐Term Mortality in Cirrhosis

Abstract

Background Alterations in body compositions are related to poor outcomes and the presence of complications in cirrhosis. However, no predictive tools combining all these anthropometric parameters are applicable in the clinical setting. We aimed to clarify the potential utility of body compositions and develop a nomogram incorporating any independent factor for prognosticating long‐term mortality in cirrhosis. Methods A total of 414 patients were randomized into primary (n = 274) and validation (n = 140) cohorts. X‐tile was performed to identify optimal cut points for stratifying participants. Multivariate Cox regression was performed, and nomogram incorporating body compositions were generated. The utility of developed models was evaluated by Harrell concordance index (C‐index), calibration curve, and decision curve analysis (DCA). Results Stratifying by X‐tilederived cut points, low skeletal muscle index (myopenia), high intramuscular adipose tissue content (myosteatosis), and the ratio of high visceral to subcutaneous adipose tissue area (adiposity) was independently associated with 3‐year mortality. A sex‐stratified nomogram incorporating anthropometric indices and clinical factors resulted in moderate discriminative accuracy, with a C‐index of 0.787 (95% CI, 0.736–0.838) and 0.789 (95% CI, 0.727–0.851) in males and females, respectively. The calibration curve showed predictive survival corresponding optimally with the actual outcomes. Our models were feasible in the clinical settings based on DCA. Similar results were observed in the validation cohort. Additionally, participants could be classified into 3 distinct risk groups by the nomogram. Conclusions Our proposed nomogram embedding body compositions rendered an individualized predictive tool for long‐term mortality in cirrhosis.

Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis

“…1). 13,15,26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] We also contacted authors of 26 studies and obtained detailed data from 7 of these studies for subgroup analyses. 13,26,30,34,36,39,40 Table 1 summarizes the characteristics of all studies included in this meta-analysis.…”

“…Overall, 9 of the 22 included studies were from Asia, 15,[30][31][32][33][34]41,43,46 and 13 studies were from non-Asia regions. 13,26,28,29,[35][36][37][38][39][40]42,44,45 Seventeen of the 22 studies were retrospective cohort studies, 15,[28][29][30][31][32][33][34][35][36][37]40,41,[43][44][45][46] four studies were prospective cohort studies, 13,26,38,39 and one cohort study included both retrospective and prospective components. 42 The sample size of the included studies ranged from 124 to 711.…”

Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis

“…Notably, sarcopenia was defined according to our previous publication as a SMI < 46.96 cm 2 /m 2 for male and SMI < 32.46 cm 2 /m 2 for female. 2 A weaker correlation has been reported between sarcopenia and various adverse outcomes in female. 15,16 Thus we hypothesized that muscle quality would be more closely relevant to frailty phenotype.…”

“…17 Accordingly, the muscle quality was determined by intramuscular adipose tissue content (IMAC) at the L3 level, whose efficacy and feasibility has been validated by us and others. 2,18,19 IMAC was calculated by dividing the CT attenuation of the multifidus muscles (HU) by that of subcutaneous adipose tissue (HU). Higher IMAC reveals a greater amount of fat infiltration in muscle tissue and, therefore, a lower quality of muscle (myosteatosis).…”

“…Frailty and sarcopenia are prevalent in patients with cirrhosis, and both have been proved to negatively impact morbidity and mortality. 1–4 Although accumulating evidence indicates that sarcopenia might serve as a component of frailty, frailty itself is more multi-faceted than sarcopenia alone. 5 Tapper et al .…”