Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

Abstract

BackgroundSarcopenia is associated with a poor prognosis in patients with liver cirrhosis. However, it is not known whether the rate of skeletal muscle depletion is also associated with a poor prognosis. We investigated the prognostic impact of the rate of skeletal muscle depletion in patients with liver cirrhosis.MethodsWe included retrospectively all patients with liver cirrhosis who underwent both multiple computed tomography scans and hepatic venous pressure gradient (HVPG) measurements.ResultsA total of 131 patients with liver cirrhosis were enrolled. The mean age of the patients was 53.7 years and alcoholic liver disease was the most common cause (61.8%). Sixty-four patients (48.9%) were diagnosed with sarcopenia. The median changes in skeletal muscle area per year (ΔSMA/y) were −0.89%. During a median follow-up period of 46.2 months (range, 3.4–87.6), 45 patients (34.4%) died. In multivariate analyses, age, Child-Pugh score, HVPG, presence of sarcopenia and ΔSMA/y were independently associated with mortality. Cumulative mortality was significantly higher in patients with ΔSMA/y < −2.4% than those with ΔSMA/y ≥ −2.4% (log-rank test, P < 0.001).ConclusionBoth the presence and rate of change of sarcopenia are independently associated with long-term mortality in patients with liver cirrhosis.

Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis

“…1). 13,15,26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] We also contacted authors of 26 studies and obtained detailed data from 7 of these studies for subgroup analyses. 13,26,30,34,36,39,40 Table 1 summarizes the characteristics of all studies included in this meta-analysis.…”

Muscle depletion in cirrhotic patients assessed using computed tomography: a cross-sectional study

“…Using a cutoff point established by Prado et al, 27 they found a prevalence of 48.9%. 28 Tandon et al also evaluated cirrhotic patients (most of them compensated) in outpatient follow-up with CT or magnetic resonance imaging, and found a prevalence of 43%. 29 Among non-liver transplantation cirrhotic patients evaluated using CT, Hanai et al…”

The Impact of Sarcopenia and Its Rate of Change on Prognostic Value of Liver Cirrhosis

“…In a retrospective review of 131 patients, Jeong et al 4 investigated the prognostic impact of the rate of skeletal muscle depletion in liver cirrhosis and compared it with the impacts of Child-Pugh (CP) score, MELD score and hepatic venous pressure gradient (HVPG). Among the patients, 64 patients (48.9%) were diagnosed with sarcopenia and the mean relative change in skeletal muscle area per year (ΔSMA/y) was −0.88% ± 8.69%.…”

“…In analysis of the presence of sarcopenia and the rate of skeletal muscle depletion together, patients without sarcopenia & ΔSMI/y ≥ −2.4% showed the best survival rate. Jeong et al 4 therefore claimed that both the presence of sarcopenia and its rate of change are associated with long term mortality in patients with liver cirrhosis, independent of liver function and portal hypertension. Accordingly, they suggest that efforts to reverse muscle mass loss improve the prognosis of patients with cirrhosis.…”

“…In some series where men and women were analyzed separately, it appeared that sarcopenia was predictive of mortality in men but not in women, and sarcopenia was more common in men than in women (58.5% vs. 24.3%, P < 0.001). 4 However, gender-specific prognostic implications of sarcopenia and the rate of skeletal muscle depletion were not described in detail.…”