Loss of paraspinal muscle mass is a gender‐specific consequence of cirrhosis that predicts complications and death

Abstract

Summary Background Loss of skeletal muscle mass is a recognised complication with a prognostic impact in patients with cirrhosis. Aim To explore in a retrospective analysis which muscle compartment most reliably predicts the occurrence of cirrhosis‐associated complications and if there are gender‐related differences. Methods 795 patients with cirrhosis listed for liver transplantation between 2001 and 2014 met the inclusion and exclusion criteria including an abdominal CT scan (±200). Controls were 109 patients who underwent a CT scan after polytrauma. The paraspinal muscles index (PSMI), the abdominal wall muscles index (AWMI) and its combination skeletal muscle index (SMI) were assessed at L3/L4, normalised to the height (cm2/m2). Results 62.0% of patients with cirrhosis had alcoholic liver disease, and 70.6% were male. As compared to controls, a reduction in PSMI and SMI but not AWMI was associated with high model of end‐stage liver disease (MELD) score, high Child‐Pugh class, and the presence or history of cirrhosis‐associated complications in males but not females. PSMI independently predicted the occurrence of bacterial infections (HR 0.932), spontaneous bacterial peritonitis (HR 0.901), hepatic encephalopathy (HR 0.961), and hepatorenal syndrome (HR 0.946) by multivariate Cox regression analysis in a gender‐independent manner. Post‐transplant survival was not associated with the PSMI; neither AWMI nor SMI predicted any clinical endpoints. Conclusions This study links muscle wasting in patients with cirrhosis predominantly to males. However, the presence of a low PSMI mass is a gender‐independent predictor of developing cirrhosis‐associated complications and death. Scores combining the MELD with muscle parameters should be re‐validated by utilizing the PSMI.

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

“…. A total of 38 articles (years 2010‐2018) were included, in which 92% (n = 35) were conducted in adults and 8% (n = 3) were conducted in pediatric populations …”

“…Only 1 article evaluated post‐LT SO . Most of the studies were performed retrospectively (n = 30/35) . The sample size ranged from 40 to 795 patients who were aged between 50 and 61 years.…”

“…CT was the most commonly used body composition method (n = 30/35), followed by BIA (n = 3/35) and concurrent use of CT and MRI (n = 2/35) . In studies that used an imaging modality (n = 32/35), there were inconsistencies in lumbar vertebrate measurement level (62% at L3, 16% at L4, 16% at L3/L4, and 6% at umbilical level [UL]). A total of 16/32 studies used total skeletal muscle area (SMA) to define sarcopenia, whereas 44% (n = 14/32) based their assessment on a single psoas muscle area (PMA) .…”

“…One study used 3 muscle parameters (paraspinal muscle mass area [PSMA], abdominal wall muscle area [AWMA], and SMA) in defining sarcopenia, whereas another study measured psoas muscle thickness (PMT) instead of the muscle area . Most of the studies (n = 25/32) normalized muscle area to height . The height correction is suggested because muscle mass is highly correlated with height .…”

“…More than half of the adult studies (n = 19/35; 54%) received NOS scoring of <7, indicative of poor study quality (Table ) . Low study quality is primary due to lack of adjustment of confounding variables, such as age, sex, race, or MELD score, that may cause bias in results.…”