Obesity and accumulation of subcutaneous adipose tissue are poor prognostic factors in patients with alcoholic liver cirrhosis

Abstract

In alcoholic liver cirrhosis (LC) patients, obesity has become a problem that progresses into liver dysfunction. Herein, we investigated the relationship between the prognosis of steatohepatitis and body weight, along with fat accumulation in patients with alcoholic LC. We conducted a single-center retrospective study, enrolled 104 alcoholic LC patients without hepatocellular carcinoma (HCC) based on histological and clinical evidence, and investigated factors related to poor prognosis using multivariate Cox regression and cluster analyses. Cox regression analysis revealed three independent relevant factors: subcutaneous adipose tissue (SAT) index (median 34.8 cm2/m2, P = 0.009, hazard ratio [HR] 1.017, 95% confidence interval [CI] 1.004–1.030), total bilirubin level (median 1.7 mg/dL, P = 0.003, HR 1.129, 95% CI 1.042–1.223), and prothrombin time value (median 64%, P = 0.007, HR 0.967, 95% CI 0.943–0.991). In the cluster analysis, we categorized the patients into three groups: no adipose tissue accumulation (NAT group), SAT prior accumulation (SAT group), and visceral adipose tissue prior accumulation (VAT group). The results of the three groups revealed that the SAT group displayed a significantly poor prognosis of the Kaplan–Meier curve (67.1 vs 21.2 vs 65.3, P<0.001) of a 5-year survival rate. Propensity score matching analysis of the SAT and VAT groups was performed to adjust the patient’s background, but no significant differences were found between them; however, the prognosis was poorer (21.2 vs 66.3, P<0.001), and hemostatic factors were still at a lower level in the SAT group. These findings suggest that SAT accumulation type of obesity is a poor prognostic factor in alcoholic LC patients without HCC, and the hemorrhagic tendency might worsen the poor prognosis in such cases.

Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis

“…The third study enrolled 104 patients with cirrhosis due to alcohol‐associated liver disease and showed a shorter survival in patients with increased subcutaneous fat mass. [ 20 ] Finally, a fourth study evaluated sarcopenia in 109 patients with CT who underwent hepatic vein pressure gradient measurement, and revealed sarcopenia as an independent risk factor for increased mortality. [ 21 ] Recently two other studies evaluated fat mass and myosteatosis at L3 in especially the perioperative setting, implying that at the timepoint of transplantation, body composition acts as a prognostic factor.…”

Sarcopenic Obesity in Liver Cirrhosis: Possible Mechanism and Clinical Impact

“…In male cirrhotic patients with hepatocellular carcinoma (HCC) undergoing liver transplantation, a visceral adipose tissue ≥ 65 cm 2 /m 2 raised the risk of HCC recurrence more than five times [51]. Accumulation of subcutaneous adipose tissue can be an adverse predictor in patients with alcoholic LC [52]. High subcutaneous adipose tissue density and high visceral adipose tissue density on CT significantly correlated negatively with survival in HCC patients [53].…”

Clinical characteristics of sarcopenia in patients with alcoholic liver cirrhosis

“…LC was diagnosed based on laboratory tests, morphological findings on imaging (ultrasonography, computed tomography, and/or magnetic resonance), and presentation of portal hypertension (such as esophageal/gastric varices and ascites). ALC was diagnosed based on LC with current and/or past history of heavy alcohol consumption (>60 g/day) and exclusion of other etiologies, such as hepatitis B or C, autoimmune hepatitis, primary biliary cholangitis, and non‐alcoholic steatohepatitis 17 . Current drinking was defined as continuous heavy alcohol consumption at least within the previous month preceding the survey.…”