Adipopenia correlates with higher portal pressure in patients with cirrhosis

Abstract

Background & Aims In cirrhosis, hepatic venous pressure gradient (HVPG) and imaging body composition assessment can influence prognosis. We assessed whether adipose and skeletal muscle tissues reflect the severity of portal hypertension (PH), and whether they improve non‐invasive prediction of decompensation and death. Methods We included 84 cirrhosis patients with HVPG and computed tomography (CT) within 12 weeks of HVPG at a single centre. L3 vertebra CT images were used for body composition indexes (cm2/m2): total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), intramuscular adipose tissue index (IMATI), skeletal muscle index (SMI) and psoas muscle index (PMI). Correlations were calculated between indexes, HVPG and standard non‐invasive tests for PH. Twelve‐month decompensation and death predictors were determined. Results The following were the characteristics for the patients included in the study: male 61%; BMI 28 ± 5 kg/m2; alcoholic liver disease in 51%, non‐alcoholic steatohepatitis in 24%; HVPG 14 ± 6 mm Hg; 45% compensated. The median follow‐up was 11 (4‐17) months. HVPG correlated with SATI (r = −0.282, P = 0.01), TATI (r = −0.220, P = 0.045) and SATI/VATI index (r = −0.240, P = 0.03). In compensated patients, lower VATI (HR 0.94 (0.90‐0.99), P = 0.01) was associated with 12‐month decompensation. Combining TATI and liver stiffness × spleen size over‐platelet count risk score added discriminative capacity for 12‐month decompensation (AUROC 0.91 vs 0.87). IMATI was independently associated with mortality in decompensated patients. MELD‐Na combined with IMATI discriminated excellently for mortality (AUROC 0.94; P < 0.001). Conclusions Hepatic venous pressure gradient inversely correlates with imaging markers of adipose tissue, while markers of sarcopenia were unrelated to PH. In compensated patients, TATI improves non‐invasive prediction of decompensation. In decompensated patients, IMATI independently predicted mortality.

Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

“…There was also a significant but inverse correlation between SATI and hepatic venous pressure gradient, mainly in females and decompensated patients. No association between sarcopenia and hepatic venous pressure gradient was observed in this study 84 . Thus, suggesting a link between SATI and portal hypertension.…”

“…Concurrent presence of low SMI and low TATI was associated with poor survival in hepatocellular carcinoma patients treated with sorafenib 83 . Adipopenia was also associated with decompensation in patients with cirrhosis 84 . This highlights the emerging role of adipopenia in prognostication in patients with advanced liver diseases; adipopenia may occur prior to sarcopenia development.…”

“…No association between sarcopenia and hepatic venous pressure gradient was observed in this study. 84 Thus, suggesting a link between SATI and portal hypertension.…”

Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

“…The metabolic pattern associated with fat loss in female patients with cirrhosis is comparable to chronic diseases or starvation, whereas the metabolic link to muscle loss in male patients is similar to the critical disease [21]. Moreover, sarcopenia was mainly related to mortality in patients with decompensated cirrhosis, whereas adipose tissue atrophy (adipopenia) was associated with mortality in a group of patients with compensated cirrhosis [22]. Although around 90% of the patients in this study were male, they might not yet have been placed in the catabolic state associated with the depletion of muscle tissue and were not experiencing the severe exhaustion of body muscle reservoirs that happens at later stages of the disease.…”

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

“…Emerging evidence has suggested 2 major body composition compartments—skeletal muscle and adipose tissue—exhibit independent features and distinct functions 1,2 . Abnormalities in these anthropometric parameters might interplay with the liver, subsequently leading to the development of cirrhosis‐related complications and, ultimately, death 3 . Computed tomography (CT) analysis of muscle‐ and fat‐tissue depositions is regarded as an objective, precise, and reliable approach.…”