Sex is a major effect modifier between body composition and mortality in patients with cirrhosis assessed for liver transplantation

Abstract

Background and Aims: Body composition predicts mortality in patients with cirrhosis.The impact of sex on this association is unknown. We investigated the impact of sex on this association in patients with cirrhosis assessed for liver transplantation.Methods: This single-centre retrospective cohort study included adults assessed for liver transplantation. Nutritional status was assessed using the Royal Free Hospital-Global Assessment (RFH-GA). Body composition at the third lumbar vertebrae was determined. Sarcopenia SMI was defined as Skeletal Muscle Index <50 cm 2 /m 2 in males and <39 cm 2 /m 2 in females. Sarcopenia PMI was defined as the sex-specific 25th percentile of the Psoas Muscle Index. Patients were assessed for the occurrence of liver transplantation and death. Analyses were stratified by sex. Results:The cohort comprised 628 patients, including 199 females and 429 males.Both groups were similar in terms of baseline liver disease severity by Model for Endstage Liver Disease (MELD) (p = .98) and nutritional status (p = .24). Sarcopenia SMI was present in 41% of males compared to 27% of females (p < .001). In the male cohort, when adjusted for age and MELD, sarcopenia PMI (aHR 1.74, 95% CI 1.08-2.80) and RFH-GA (aHR 1.40, 95% CI 1.03-1.90) remained independent predictors of mortality.Adipose tissue had no impact on outcomes in males. In female patients, adipose tissue (TATI or VATI depending on the multivariable model) was independently associated with mortality, whereas sarcopenia and malnutrition were not. Conclusions:This study demonstrates that male patients were susceptible to low muscle mass, whereas female patients were not. Future research in this patient population should minimize sex-related bias and present data for both groups separately.

Prevalence of Sarcopenia in Liver Cirrhosis: A Systematic Review and Meta-Analysis

“…Two entries by Kim et al ( 24 , 29 ) applied the sarcopenia index, that is, the ratio of total appendicular skeletal muscle mass (kg) to body mass index (kg/m 2 ), using consistent cutoffs of <0.789 for men and <0.521 for women. Two sarcopenia entries Resulted from muscle deficits estimated by the psoas muscle index of L3 ( 32 , 35 ). Finally, a single prevalence entry was derived from the construct used by ( 37 ), namely, a paraspinal muscle index deficiency, diagnosed on values <12.62 cm 2 /m 2 for men and <9.77 cm 2 /m 2 for women.…”

Radiological psoas muscle parameters as a reliable tool for detection of sarcopenia and prediction of short-term survival in liver cirrhosis

“…Hight prevalence of sarcopenia in our cohort was probably related with LC decompensation in vast majority of patients and >20 MELD in more than two-thirds of patients at baseline. A number of studies have demonstrated an association between LC severity, alcohol-related etiology, male sex, and sarcopenia incidence [2,8,20,32]. In our cohort, the incidence of sarcopenia increased along with the disease stage and reached 86.3 % in CTP C patients.…”

“…In another study, low PMI values, independent of MELD, were associated with adverse posttransplant results: infectious complications, prolonged ventilation and intensive care, and higher oneyear mortality [11]. Three studies published this year show that PMI-assessed sarcopenia is associated with reduced survival of LC patients awaiting transplantation and patients who have already undergone transplantation, as well as survival of hepatocellular carcinoma patients receiving immune and targeted anticancer therapy [2,25,35]. Thus, the psoas muscle dimensions were considered a reliable tool for detection of sarcopenia and prediction of short-term survival in LC.…”

Sarcopenia evaluated by EASL/AASLD computed tomography-based criteria predicts mortality in patients with cirrhosis: A systematic review and meta-analysis

“…, patients with HCC, at TIPS placement, or post-LT), 17 had insufficient data, and 12 had overlapping cohorts. Finally, 39 studies met the inclusion criteria [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] and were included in the main analysis, representing a total of 12,827 patients. Data from eight additional studies 12 , [55] , [56] , [57] , [58] , [59] , [60] , [61] from the overlapping cohorts were used in the subgroup analyses.…”

“…The characteristics of the included studies are shown in Table 1 . Briefly, 19 studies were conducted in Asia, 16 , 18 , [20] , [21] , [22] , [24] , [25] , [26] , [27] , 29 , 31 , 32 , 38 , 39 , 45 , 46 , 48 , 50 , 53 12 studies in Europe, 17 , 19 , 23 , 28 , 34 , 36 , 40 , 41 , 44 , 47 , 49 , 54 six studies in North America, 30 , 33 , 37 , 42 , 43 , 52 one in Latin America (Argentina) 35 and one in Oceania (Australia). 51 Only eight studies were prospective, 16 , 20 , 21 , 23 , 31 , 34 , 37 , 49 and the rest were retrospective.…”