Sarcopenia HIBA score predicts sarcopenia and mortality in patients on the liver transplant waiting list

Abstract

Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio[OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR:1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007).The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.

Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis

“…At present, CT is the most accurate and accessible method for diagnosing sarcopenia in cirrhosis patients, and it is difficult to perform CT scans at short intervals owing to the radiation risk and cost. Recently, to overcome this limitation, a model for predicting sarcopenia using blood test results in cirrhosis patients has been developed; however, further validation is still needed [ 32 , 33 ]. Second, cirrhotic patients with Child-Pugh scores >10 and serum creatinine >1.5 mg/dL were excluded at inclusion.…”

Enhancing ACLF prediction by integrating sarcopenia assessment and frailty in liver transplant candidates on the waiting list

“… 18 The MELD, 19 MELD-Na, 20 MELD 3.0, 21 MELD-CysC 22 GEMA-Na 23 and MELD-sarcopenia 24 scores were calculated at inclusion in the WL for LT. Finally, at the time of inclusion on the WL, nutritional assessment was performed by SGA; 25 body composition was assessed by CT at the third lumbar vertebrae (L3) level; 7 sarcopenia was assessed by CT SMI at the L3 level, 26 sarcopenia HIBA score, 9 and thigh muscle thickness measured by US; 8 frailty was assessed by LFI, 10 HGS, 12 and 6MWT. 11 …”

“… 7 However, the cost and radiation risk limit the use of this method for screening and follow-up of sarcopenia. 1 In this context, different tools, such as thigh muscle thickness measured by ultrasound (US), 8 or clinical-serological scores based on the creatinine/cystatin C ratio, such as the sarcopenia HIBA score, 9 have emerged as surrogate tools for detecting these conditions. Finally, frailty in patients with cirrhosis is the phenotypic representation of impaired contractile muscle function, 3 , 4 with the liver frailty index (LFI), 10 6-minute walk test (6MWT), 11 and handgrip strength (HGS) 12 being the three most valid objective tools in advanced liver disease.…”

Simple bedside tests as an alternative to sarcopenia HIBA score in predicting sarcopenia and mortality in cirrhosis

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We read with great interest the study by Mauro et al, in which they devised the "Sarcopenia HIBA score" that predicts sarcopenia and mortality in patients on the liver transplant wait list. [1] We congratulate the authors for proposing a simple score that predicts the presence of sarcopenia and wait-list mortality in patients with cirrhosis.However, we want to highlight certain reservations about this score and the issue of sarcopenia assessment as a whole. The authors mentioned the area under the receiver operating characteristic curve (AUROC) value of 0.862 of the sarcopenia HIBA score at a cutoff value of −2.09 with an accuracy of 61.4%.

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“…We read with great interest the study by Mauro et al, in which they devised the "Sarcopenia HIBA score" that predicts sarcopenia and mortality in patients on the liver transplant wait list. [1] We congratulate the authors for proposing a simple score that predicts the presence of sarcopenia and wait-list mortality in patients with cirrhosis.…”