Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

Montano‐Loza, Aldo J.; Meza–Junco, Judith; Baracos, Vickie E.; Prado, Carla M.; Ma, Mang; Meeberg, Glenda; Beaumont, Crystal; Tandon, Puneeta; Esfandiari, Nina; Sawyer, Michael B.; Kneteman, Norman M.

doi:10.1002/lt.23863

Cited by 264 publications

(266 citation statements)

References 36 publications

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“…chemotherapy), resulting in substantial losses of musculature 1, 2, 29. The presence of lower than normal muscularity, or the muscle atrophy that occurs during hospitalization or treatment, has several deleterious consequences for the patient, including increased length of stay and rates of readmission to the hospital,30, 31 increased rates of mortality,3, 4, 32 and a loss of strength and functional capacity 2. Developing targeted nutritional or rehabilitative therapies to attenuate muscle atrophy during these periods is critical for improving quality of life and independence for these patients.…”

Section: Discussionmentioning

confidence: 99%

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Paris

Lafleur

Dubin

et al. 2017

J cachexia sarcopenia muscle

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BackgroundUltrasound is a non‐invasive and readily available tool that can be prospectively applied at the bedside to assess muscle mass in clinical settings. The four‐site protocol, which images two anatomical sites on each quadriceps, may be a viable bedside method, but its ability to predict musculature has not been compared against whole‐body reference methods. Our primary objectives were to (i) compare the four‐site protocol's ability to predict appendicular lean tissue mass from dual‐energy X‐ray absorptiometry; (ii) optimize the predictability of the four‐site protocol with additional anatomical muscle thicknesses and easily obtained covariates; and (iii) assess the ability of the optimized protocol to identify individuals with low lean tissue mass.MethodsThis observational cross‐sectional study recruited 96 university and community dwelling adults. Participants underwent ultrasound scans for assessment of muscle thickness and whole‐body dual‐energy X‐ray absorptiometry scans for assessment of appendicular lean tissue. Ultrasound protocols included (i) the nine‐site protocol, which images nine anterior and posterior muscle groups in supine and prone positions, and (ii) the four‐site protocol, which images two anterior sites on each quadriceps muscle group in a supine position.ResultsThe four‐site protocol was strongly associated (R 2 = 0.72) with appendicular lean tissue mass, but Bland–Altman analysis displayed wide limits of agreement (−5.67, 5.67 kg). Incorporating the anterior upper arm muscle thickness, and covariates age and sex, alongside the four‐site protocol, improved the association (R 2 = 0.91) with appendicular lean tissue and displayed narrower limits of agreement (−3.18, 3.18 kg). The optimized protocol demonstrated a strong ability to identify low lean tissue mass (area under the curve = 0.89).ConclusionsThe four‐site protocol can be improved with the addition of the anterior upper arm muscle thickness, sex, and age when predicting appendicular lean tissue mass. This optimized protocol can accurately identify low lean tissue mass, while still being easily applied at the bedside.

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Section: Discussionmentioning

confidence: 99%

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Paris

Lafleur

Dubin

et al. 2017

J cachexia sarcopenia muscle

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“…Cut-off values for sarcopenia were derived from a CT-based study of 1,473 patients with solid tumors (18), which has been utilized previously in cirrhotic patients (6). Threshold values for sarcopenia were SMI <41 cm 2 /m 2 for women, SMI <43 cm 2 /m 2 for men with BMI <25 kg/m 2 , and SMI <53 cm 2 /m 2 for men with BMI ≥25k g/m 2 .…”

Section: Methodsmentioning

confidence: 99%

“…Reduced muscle attenuation was based on published cut-off values (18) that have been previously used in patients with cirrhosis (6). Threshold values for reduced muscle attenuation were SMA <41 HU for patients with BMI <25 kg/m 2 and SMA <33 HU for patients with BMI ≥25 kg/m 2 .…”

Section: Methodsmentioning

confidence: 99%

“…Sarcopenia has been linked to increased wait-list and posttransplant mortality, as well as increased infection and longer posttransplant length of stay (3–6). Reduced muscle quality, as determined by fat infiltration seen at imaging, also contributes to poor physical condition and is associated with higher mortality after living donor liver transplantation (7).…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Muscle Function, Mass, and Quality in Liver Transplant Candidates

et al. 2016

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Background Sarcopenia and functional impairment are common and lethal extra-hepatic manifestations of cirrhosis. We aimed to determine the association between computed-tomography (CT)-based measures of muscle mass and quality (sarcopenia) and performance-based measures of muscle function. Methods Adults listed for liver transplant underwent testing of muscle function [grip strength, Short Physical Performance Battery (SPPB)] within 3 months of abdominal CT. Muscle mass (cm2/m2) =total cross-sectional area of psoas, paraspinal, and abdominal wall muscles at L3 on CT, normalized for height. Muscle quality=mean Hounsfield units (HU) for total skeletal muscle area at L3. Results Among 292 candidates, median grip strength was 31kg, SPPB score was 11, muscle mass was 49cm2/m2, and muscle quality was 35HU. Grip strength weakly correlated with muscle mass (ρ=0.26, p<0.001) and quality (ρ=0.27; p<0.001) in men, and muscle quality (ρ=0.23, p=0.02), but not muscle mass, in women. SPPB correlated weakly with muscle quality in men (ρ=0.38; p<0.001) and women (ρ=0.25; p=0.02), however did not correlate with muscle mass in men or women. After adjustment for gender, MELD-Na, hepatocellular carcinoma, and BMI, grip strength (HR 0.74, 95%CI 0.59–0.92, p=0.008), SPPB (HR 0.89, 95%CI 0.82–0.97, p=0.01), and muscle quality (HR 0.77, 95%CI 0.63–0.95, p=0.02) were associated with wait-list mortality, but muscle mass was not (HR 0.91, 95%CI 0.75–1.11, p=0.35). Conclusions Performance-based tests of muscle function are only modestly associated with CT-based muscle measures. Given that they predict wait-list mortality and can be conducted quickly and economically, tests of muscle function may have greater clinical utility than CT-based measures of sarcopenia.

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“…In a study of cirrhotic patients awaiting liver transplantation, the combination of mid-arm muscle circumference < 23 cm and hand grip strength < 30 kg had a 94% sensitivity and 97% negative predictive value when compared to body cell mass as determined by isotope dilution technique [13, 14]. Cross-sectional measurement of paraspinal skeletal muscle area using computed tomography has been evaluated in both pre- and post-transplant settings [15–17]. Nonetheless, there are no global markers of malnutrition that capture the multifactorial pathogenesis of this condition in cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Serum Leptin Is a Biomarker of Malnutrition in Decompensated Cirrhosis

et al. 2016

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Background and AimsMalnutrition is a leading cause of morbidity and mortality in cirrhosis. There is no consensus as to the optimal approach for identifying malnutrition in end-stage liver disease. The aim of this study was to measure biochemical, serologic, hormonal, radiographic, and anthropometric features in a cohort of hospitalized cirrhotic patients to characterize biomarkers for identification of malnutrition.DesignIn this prospective observational cohort study, 52 hospitalized cirrhotic patients were classified as malnourished (42.3%) or nourished (57.7%) based on mid-arm muscle circumference < 23 cm and dominant handgrip strength < 30 kg. Anthropometric measurements were obtained. Appetite was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ) score. Fasting levels of serum adipokines, cytokines, and hormones were determined using Luminex assays. Logistic regression analysis was used to determine features independently associated with malnutrition.ResultsSubjects with and without malnutrition differed in several key features of metabolic phenotype including wet and dry BMI, skeletal muscle index, visceral fat index and HOMA-IR. Serum leptin levels were lower and INR was higher in malnourished subjects. Serum leptin was significantly correlated with HOMA-IR, wet and dry BMI, mid-arm muscle circumference, skeletal muscle index, and visceral fat index. Logistic regression analysis revealed that INR and log-transformed leptin were independently associated with malnutrition.ConclusionsLow serum leptin and elevated INR are associated with malnutrition in hospitalized patients with end-stage liver disease.

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Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation

Cited by 264 publications

References 36 publications

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass

A Comparison of Muscle Function, Mass, and Quality in Liver Transplant Candidates

Serum Leptin Is a Biomarker of Malnutrition in Decompensated Cirrhosis

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