Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis

Abstract

Muscle alterations (myosteatosis and sarcopenia) are frequent in cirrhosis and related to some complications including overt hepatic encephalopathy (HE). The aim of our study was to investigate the relationship between muscle alterations and minimal HE (MHE) and their role in the risk of overt HE. Sixty-four patients with cirrhosis were administered the Psychometric Hepatic Encephalopathy Score and animal naming test to detect MHE. Computed tomography was used to analyze the skeletal muscle index and attenuation. The incidence of the first episode of HE, taking into account the competing risk nature of the data, was estimated. Myosteatosis was observed in 24 patients (37.5%), sarcopenia in 37 (58%), and MHE in 32 (50%). Both myosteatosis (62.5% versus 12.5%, P < 0.001) and sarcopenia (84% versus 31%, P < 0.001) were more frequent in patients with MHE. The variables independently associated with the presence of MHE were sarcopenia, previous overt HE, and myosteatosis. Thirty-one (48%) patients developed overt HE over 16.1 ± 13 months; myosteatosis was detected in 68% and sarcopenia in 84% of them. Sarcopenia and myosteatosis were also independently associated with the development of overt HE. Venous ammonia was significantly higher in patients with sarcopenia (62.6 ± 17.7 versus 41.4 ± 16.1 μg/dL, P < 0.001) and in patients with myosteatosis (65.2 ± 19.2 versus 46.7 ± 17.1 μg/dL, P < 0.001) and inversely correlated to both parameters. Survival was significantly lower in malnourished patients compared to patients without myosteatosis or sarcopenia (P < 0.001). Conclusion: Myosteatosis and sarcopenia, probably by reducing the handling of ammonia in the muscle, are independently associated with MHE and the risk of overt HE in patients with cirrhosis; in malnourished patients, the amelioration of nutritional status may be a goal to decrease both the prevalence of MHE and the incidence of overt HE.

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

“…Despite the lack of interaction between sarcopenia and myosteatosis in our study, which is contrary to what was found by Tachi et al, 68 both were independent predicrors of hepatic encephalopathy 42 . Higher serum levels of ammonia and greater frequency of sarcopenia and myosteatosis were recently observed in patients with cirrhosis and minimal hepatic encephalopathy 69 …”

The value of different CT‐based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis

“…Furthermore ammonia levels do not correlate with the severity of hepatic encephalopathy . Another possible explanation might be the link between muscle wasting and already minimal hepatic encephalopathy (MHE) as suggested by a recent study . MHE was at the time not generally evaluated in our cohort, therefore we might have under‐diagnosed MHE and this could represent the possible bias why we found no link between HE and muscle wasting.…”

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

“…These findings were confirmed in another study of 128 cirrhotic patients by Kalaitzakis et al who showed that sarcopenia is an independent risk factor for HE when adjusted for age, Child‐Pugh score, and presence of diabetes mellitus . Furthermore, Nardelli et al showed that myosteatosis and sarcopenia are independently associated with minimal HE and increased risk of overt HE in cirrhotic patients . Association between muscle wasting and HE was confirmed in 2 studies from Italy on post‐TIPS cirrhotic patients …”