Sarcopenic obesity in cirrhosis—The confluence of 2 prognostic titans

Eslamparast, Tannaz; Montano‐Loza, Aldo J.; Raman, Maitreyi; Tandon, Puneeta

doi:10.1111/liv.13876

Cited by 105 publications

(136 citation statements)

References 106 publications

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“…2,15 The sensitivity of these techniques to differentiate between muscle quantity and quality, however, is limited and often biased by the significant amount of fluid overload in patients with terminal liver disease. Results of the logistic regression were given as odds ratios with 95% confidence interval.…”

Section: Major Complications (Cd ≥ 3b) a N = 114mentioning

confidence: 99%

“…15 In a recent report by TA B L E 6 The "BAR-Myosteatosis" score clinical outcomes (especially in terms of perioperative outcome). Although earlier studies investigated changes in skeletal muscle mass to define sarcopenia, recent evidence suggests that fat accumulation within the muscle might be responsible for functional impairment and negative pathophysiological responses even in patients with quantitatively normal or nearly normal muscle mass.…”

Section: Major Complications (Cd ≥ 3b) a N = 114mentioning

confidence: 99%

“…[5][6][7] In the face of critical organ shortage with increased utilization of marginal allografts procured from extended criteria donors (ECD), one of the most challenging clinical decisions in the liver transplantation setting is the optimal risk-quantification and the identification of high-risk recipients and/or donor-recipient combinations. 2,15 The importance of nutritional status and its assessment in patients with chronic liver disease are further highlighted by the recent European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) guidelines on nutrition in chronic liver disease. [8][9][10][11][12][13] While some of these models are helpful in predicting posttransplant outcomes, none of these scores include information on the recipient's BC.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13] While some of these models are helpful in predicting posttransplant outcomes, none of these scores include information on the recipient's BC. While some studies have recently reported an association of sarcopenia with clinical outcome in cirrhosis and orthotopic liver transplantation (OLT), 15,[19][20][21][22][23] the prognostic value of muscle quality (skeletal muscle density and myosteatosis) compared to muscle quantity (skeletal muscle mass-SMM, as the morphological aspect of sarcopenia) remains to be determined. 2,15 The importance of nutritional status and its assessment in patients with chronic liver disease are further highlighted by the recent European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) guidelines on nutrition in chronic liver disease.…”

Section: Introductionmentioning

confidence: 99%

“…All measurements were performed by the same researcher, experienced in complex image analysis and segmentation techniques.Based on the SMI and SM-RA, reduced skeletal muscle mass and myosteatosis were defined using cut-off values determined specifically for patients on the OLT waiting list (SMI: female 39 cm 2 /m 2 , male 50 cm 2 /m 2 ; SM-RA <41 HU for patients with a body mass index [BMI] up to 24.9 kg/m 2 and <33 HU for patients with a BMI ≥25 kg/m 2 ) 15,25. Established cut-off value of ≥100 cm 2 has been used for VFA to identify patients with visceral obesity 15. Sarcopenic obesity was defined as the combination of reduced SMI and high VFA.…”

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confidence: 99%

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Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Czigány

Kramp

Bednarsch

et al. 2020

American Journal of Transplantation

119

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abbreviations: AASLD American Association for the Study of Liver Diseases AUC area under the curve AUROC area under the receiver operating characteristics curve BAR balance of risk BC body composition BMI body mass index CCI comprehensive complication index CDC lavien-Dindo classification CT computed tomography EAD early allograft dysfunction EASL European Association for the Study of the Liver ECD extended criteria donor FFP unitsfresh frozen plasma units HU Hounsfield unit ICH International Conference on Harmonisation ICU Intensive Care Unit KPS Karnofsky Performance Score MELD Model of End-stage Liver Disease OLT orthotopic liver transplantation RBC units red blood cell units ROC receiver operating characteristics SM-RA skeletal muscle radiation attenuation SMI skeletal muscle index SMM skeletal muscle mass SOFT survival outcomes following liver transplantation TEur Thousand Euros UH-RWTH University Hospital of the RWTH University VFA visceral fat area1 Muscle wasting and alterations of body composition are linked to clinical outcomes in numerous medical conditions. The role of myosteatosis in posttransplant outcomes remains to be determined. Here we investigated skeletal muscle mass and myosteatosis as prognostic factors in patients undergoing orthotopic liver transplantation (OLT). The data of 225 consecutive OLT recipients from a prospective database were retrospectively analyzed (May 2010-December 2017). Computed tomography-based skeletal-muscleindex (muscle mass), visceral-fat-area (visceral adiposity), and mean skeletal-muscle-radiation-attenuation (myosteatosis) were calculated using a segmentation tool. Cut-off values of myosteatosis resulted in a good stratification of patients into low-and high-risk groups in terms of morbidity (Clavien-Dindo ≥3b). Patients with myosteatosis had significantly higher complication rates (90-day Comprehensive Complication Index 68 ± 32vs 44 ± 30, P < .001) and also displayed significantly longer intensive care (18 ± 25 vs 11 ± 21 days, P < .001) and hospital stay (56 ± 55 vs 33 ± 24 days, P < .001). Estimated costs were 44% higher compared to patients without myosteatosis. Multivariable analysis identified myosteatosis as an independent prognostic factor for major morbidity (odds ratio: 2.772, confidence interval: 1.516-5.066, P = .001). Adding myosteatosis to the well-established Balance-of-Risk-(BAR) score resulted in an increased prognostic value compared to the original BAR score. Myosteatosis may be a useful parameter to predict perioperative outcome in patients undergoing OLT, supporting the role of muscle quality (myosteatosis) over quantity (muscle mass) in this setting. K E Y W O R D Sbody composition, clinical decision-making, clinical research/practice, complication, liver transpla...

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Section: Major Complications (Cd ≥ 3b) a N = 114mentioning

confidence: 99%

Section: Major Complications (Cd ≥ 3b) a N = 114mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Czigány

Kramp

Bednarsch

et al. 2020

American Journal of Transplantation

119

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

et al. 2019

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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.

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Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is the first American Association for the Study of Liver Diseases (AASLD) Practice Guidance on the management of malnutrition, frailty, and sarcopenia in patients with cirrhosis. This guidance represents the consensus of a panel of experts after a thorough review and vigorous debate of the literature published to date, incorporating clinical experience and common sense to fill in the gaps when appropriate. Our goal was to offer clinicians pragmatic recommendations that could be implemented immediately in clinical practice to target malnutrition, frailty, and sarcopenia in this population. This AASLD Guidance document differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations, and, if appropriate, meta-analysis of results using the Grading of Recommendations Assessment Development and Evaluation system. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on formal review and analysis of the literature on the topics, with oversight Accepted ArticleThis article is protected by copyright. All rights reserved provided by the AASLD Practice Guidelines Committee at all stages of Guidance development. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials (RCTs) were not available to support the development of a Guideline. Definitions of Malnutrition, Frailty, and Sarcopenia and Their Relationship in Patients With CirrhosisCirrhosis is a major predisposing condition for the development of malnutrition, frailty, and sarcopenia.Multiple, yet complementary, definitions of these conditions exist in the published domain outside of the field of hepatology, but consensus definitions have not yet been established by the AASLD for patients with cirrhosis. Furthermore, there has been ambiguity related to operationalization of these constructs in clinical practice. To address this, we offer definitions of the theoretical constructs of malnutrition, frailty, and sarcopenia as commonly represented in all populations, partnered with operational definitions, developed by consensus, to facilitate pragmatic implementation of these constructs in clinical practice as applied to patients with cirrhosis (Table 1). Malnutrition is a clinical syndrome that results from "an imbalance (deficiency or excess) of nutrients that causes measurable adverse effects on tissue/body form (body shape, size, composition) or function, and/or clinical outcome." 1 Key to this definition is the recognition that malnutrition represents a spectrum of nutritional disorders across the entire range of body mass index (BMI)from underweight to obese. By this definition, malnutrition leads to adverse physical effects, which, in patients with cirrhosis, are commonly manifested phenotypically as frailty or sarcopenia. Frailty has most commonly been defined as a clinical state of decreased physiologic reserve...

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Sarcopenic obesity in cirrhosis—The confluence of 2 prognostic titans

Cited by 105 publications

References 106 publications

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

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

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

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