Skeletal Muscle Alterations Indicate Poor Prognosis in Cirrhotic Patients: A Multicentre Cohort Study in China

Abstract

Introduction: We aimed to determine the diagnostic criteria of myosteatosis in a Chinese populationand investigate the effect of skeletal muscle abnormalities on the outcomes of cirrhotic patients. Methods: Totally 911 volunteers were recruited to determine the diagnostic criteria and impact factors of myosteatosis, and 480 cirrhotic patients were enrolled to verify the value of muscle alterations for prognosis prediction and establishnew noninvasive prognostic strategies. Results: Multivariate analysis showed age, sex, weight, waist circumference and biceps circumference had remarkable influence on the L3 skeletal muscle density (L3-SMD). Based on the cut-off of a mean−1.28×SD among adults aged＜60 years, the diagnostic criteria for myosteatosis wasL3-SMD＜38.93 Hu in malesand L3-SMD＜32.82 Hu in females. Myosteatosis rather than sarcopenia has close correlation with portal hypertension. The concurrence of sarcopenia and myosteatosis not only is associated with poor liver function, but also evidently reduced the overall and liver transplantation-free survival of the cirrhotic patients (P<0.001). According to the stepwise Cox regression hazard model analysis, we established nomograms including TBil, albumin, history of HE, ascites grade, sarcopenia and myosteatosis for easily determining survival probabilities in cirrhotic patients. The AUC is 0.874 (95% CI, 0.800-0.949) for 6-month survival, 0.831 (95% CI, 0.764-0.898) for 1-year survival and 0.813 (95% CI, 0.756-0.871) for 2-year survival prediction, respectively. Conclusions: This study provides evidence of the significant correlation between skeletal muscle alterations andpoor outcomes of cirrhosis, and establishes valid and convenient nomograms incorporating musculoskeletal disorders for the prognostic prediction of liver cirrhosis. Further large-scale prospective studies are necessary to verify the value of the nomograms.