Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Ebadi, Maryam; Wang, Connie W.; Lai, Jennifer C.; Dasarathy, Srinivasan; Kappus, Matthew R.; Dunn, Michael A.; Carey, Elizabeth J.; Montaño-Loza, Aldo J.

doi:10.1002/jcsm.12349

Cited by 118 publications

(106 citation statements)

References 39 publications

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“…Our use of a contemporaneous group of age‐matched subjects without documented disorders that alter muscle mass showed that the standardized rate of muscle loss (either absolute or percentage) in cirrhosis of any aetiology is significantly greater than that due to age alone. Unlike earlier reports, in the present study we observed that all three muscle groups studied had similar predictive value for outcomes. We therefore believe that the psoas muscle area alone can be used as an indicator of muscle mass due to the ease of measurement.…”

Section: Discussioncontrasting

confidence: 73%

Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease

Welch

Dasarathy

Runkana

et al. 2020

Liver International

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Background and Aims Sarcopenia or skeletal muscle loss adversely affects outcomes in cirrhosis. The impact of aetiology of liver disease on the severity or the rate of muscle loss is not known. Methods Consecutive, well‐characterized adult patients with cirrhosis due to viral hepatitis (VH), alcoholic liver disease (ALD) or non‐alcoholic fatty liver disease (NAFLD) and non‐diseased controls with at least two temporally distinct abdominal CT (computed tomography) scans were evaluated. Psoas, paraspinal and abdominal wall muscle areas at the L3 vertebra level were quantified on the CT scans. Standardized rate of change in muscle area was expressed as change in area/100 days. Univariate and multivariable analyses were performed to identify contributors to rate of muscle loss and survival. Results Among 83 cirrhotics (NAFLD n = 26, ALD n = 39, VH n = 18), there were 20 (24.1%) deaths over 62.7 ± 41.3 months. The mean percentage change in psoas area was −0.03 ± 0.05/100d in controls and −3.52 ± 0.45/100d in cirrhosis (P < .001). The mean percentage change in psoas area was −1.72 ± 0.27/100d in NAFLD, −5.28 ± 0.86/100d in ALD and −2.29 ± 0.28/100d in VH. Among cirrhotics, patients with ALD had the lowest initial muscle area and most rapid rate of reduction in muscle area. Aetiology of liver disease, model for end‐stage liver disease (MELD) and the rate of loss of muscle area were independent risk factors for survival. Conclusions Aetiology of liver disease is an independent risk factor for sarcopenia with the greatest rate of muscle loss noted in ALD. Survival in cirrhosis was dependent on initial muscle mass, rate of muscle loss and MELD score.

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Section: Discussioncontrasting

confidence: 73%

Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease

Welch

Dasarathy

Runkana

et al. 2020

Liver International

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“…However, others have used L4 as a landmark . Furthermore, other studies have cited SMM area as a more complete measure than PMA alone because it is closely related to total body protein and wait‐list mortality . PMT as an alternative indicator to assess for sarcopenia has also been proposed, but it requires further validation .…”

Section: Discussionmentioning

confidence: 99%

“…(47) Furthermore, other studies have cited SMM area as a more complete measure than PMA alone because it is closely related to total body protein and wait-list mortality. (48,49) PMT as an alternative indicator to assess for sarcopenia has also been proposed, but it requires further validation. (32) Use of cross-sectional CT/MRI, segmental DEXA using appendicular measures, and phase angle BIA have been shown to be less influenced by overhydration than whole body measures.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

et al. 2019

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Malnutrition is a common complication in patients with end‐stage liver disease (ESLD) awaiting liver transplantation (LT). Malnutrition and sarcopenia overlap in etiology and outcomes, with sarcopenia being defined as reduced skeletal muscle mass and muscle function. The purpose of this review was to identify the prevalence of sarcopenia with and without obesity in adults and children with ESLD and to assess the methodological considerations in sarcopenia diagnosis and the association of sarcopenia with pre‐ and post‐LT outcomes. A total of 38 articles (35 adult and 3 pediatric articles) retrieved from PubMed or Web of Science databases were included. In adults, the prevalence rates of pre‐LT sarcopenia, pre‐LT sarcopenic obesity (SO), post‐LT sarcopenia, and post‐LT SO were 14%‐78%, 2%‐42%, 30%‐100%, and 88%, respectively. Only 2 adult studies assessed muscle function in patients diagnosed with sarcopenia. The presence of pre‐LT sarcopenia is associated with higher wait‐list mortality, greater postoperative mortality, higher infection risk and postoperative complications, longer intensive care unit (ICU) stay, and ventilator dependency. The emerging pediatric data suggest that sarcopenia is prevalent in pre‐ and post‐LT periods. In 1 pediatric study, sarcopenia was associated with poor growth, longer perioperative length of stay (total/ICU) and ventilator dependency, and increased rehospitalization in children after LT. In conclusion, there is a high prevalence of sarcopenia in adults and children with ESLD. Sarcopenia is associated with adverse clinical outcomes. The present review is limited by heterogeneity in the definition of sarcopenia and in the methodological approaches in assessing sarcopenia. Future studies are needed to standardize the sarcopenia diagnosis and muscle function assessment, particularly in the pediatric population, to enable early identification and treatment of sarcopenia in adults and children with ESLD.

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“…Several key questions remain regarding the use of CT-based estimation of skeletal muscle mass, including the use of values below specific percentiles (i.e., 5th percentile) of age-and sex-matched population or optimal cut-points for mortality discrimination, sensitivity of changes over time, and the validity of measurement of psoas alone versus the total muscle area. (21)…”

Section: • Nutritional Assessment By Royal Freementioning

confidence: 99%

“…In addition, low PMI identifies an incomplete subset of patients at increased risk of mortality indicated by low SMI. (21) Although sarcopenia has classically been associated with increased mortality in both men and women with cirrhosis, emerging evidence suggests that sarcopenia is associated with disproportionately higher rates of mortality in men as compared with women. (27) This emphasizes the importance of survival analysis stratification by sex rather than simply adjusting multivariable models for sex.…”

Section: Defining Sarcopeniamentioning

confidence: 99%

A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation

et al. 2019

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Loss of muscle mass and function, or sarcopenia, is a common feature of cirrhosis and contributes significantly to morbidity and mortality in this population. Sarcopenia is a main indicator of adverse outcomes in this population, including poor quality of life, hepatic decompensation, mortality in patients with cirrhosis evaluated for liver transplantation (LT), longer hospital and intensive care unit stay, higher incidence of infection following LT, and higher overall health care cost. Although it is clear that muscle mass is an important predictor of LT outcomes, many questions remain, including the best modality for assessing muscle mass, the optimal cut-off values for sarcopenia, the ideal timing and frequency of muscle mass assessment, and how to best incorporate the concept of sarcopenia into clinical decision making. For these reasons, we assembled a group of experts to form the North American Working Group on Sarcopenia in Liver Transplantation to use evidence from the medical literature to address these outstanding questions regarding sarcopenia in LT. We believe sarcopenia assessment should be considered in all patients with cirrhosis evaluated for liver transplantation. Skeletal muscle index (SMI) assessed by computed tomography constitutes the best-studied technique for assessing sarcopenia in patients with cirrhosis. Cut-off values for sarcopenia, defined as SMI < 50 cm 2 /m 2 in male and < 39 cm 2 /m 2 in female patients, constitute the validated definition for sarcopenia in patients with cirrhosis. Conclusion: The management of sarcopenia requires a multipronged approach including nutrition, exercise, and additional pharmacological therapy as deemed necessary. Future studies should evaluate whether recovery of sarcopenia with nutritional management in combination with an exercise program is sustainable as well as how improvement in muscle mass might be associated with improvement in clinical outcomes.

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Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Cited by 118 publications

References 39 publications

Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease

Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation

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