The Presence of Myosteatosis Is Associated with Age, Severity of Liver Disease and Poor Outcome and May Represent a Prodromal Phase of Sarcopenia in Patients with Liver Cirrhosis

Abstract

Background/Aims: Myosteatosis implies impaired muscle quality. The aim of the study was to investigate the association of myosteatosis with other muscle abnormalities and its role in the prognosis of liver cirrhosis (LC). Method: Skeletal muscle index (SMI) and myosteatosis were measured by computed tomography. Myosteatosis was defined as muscle radiodensity and evaluated according to dry body mass index (BMI). Median values and interquartile range were used for continuous and count (percentage) for categorical variables. Results: A total of 197 consecutive patients were included (age 61 (IQR 52–68); 67% male; MELD score 11 (interquartile range 7.5–16)). Myosteatosis was identified in 73.6% and sarcopenia in 44.6% of patients. Myosteatosis was positively associated with age (p = 0.024) and Child–Pugh (p = 0.017) and inversely associated with SMI (p = 0.026). Patients with myosteatosis exhibited lower 360-day survival (log-rank p = 0.001) compared to those without it. MELD (p < 0.001) and myosteatosis (p = 0.048) emerged as negative prognostic factors of survival in multivariate model. Individuals combining low muscle strength and impaired muscle quality and quantity displayed more advanced LC, impaired muscle performance, lower BMI (p < 0.001 each) and a three times higher mortality rate compared to those with low muscle quality alone. Conclusions: The presence of myosteatosis was associated with advanced age, low skeletal mass and more severe LC. Myosteatosis was associated with poor prognosis and may represent a prodromal phase of muscle degeneration before the development of sarcopenia.

Prevalence and impact on the outcome of myosteatosis in patients with cirrhosis: a systematic review and meta-analysis

“…Thus, 17 studies [ 11 – 27 ], that evaluated the prevalence of myosteatosis in cirrhotic patients, fulfilled all inclusion criteria and were included in the final analysis. Four studies were derived from Italy [ 11 , 18 , 20 , 22 ], three from China [ 17 , 19 , 21 ], two from Japan [ 14 , 15 ], as well as two from Germany [ 16 , 25 ] and the USA [ 24 , 27 ] and one from Canada [ 12 ], Greece [ 13 ], South Africa [ 26 ] and the Netherlands [ 23 ]. In only one study [ 24 ] MRI was used for the evaluation of myosteatosis.…”

“…According to the available data, mean CP and MELD scores were 7.2 and 13.8, respectively. Chronic viral hepatitis (B or C) was the underlying cause of cirrhosis in 39% (n = 1615) of patients, while HCC was present in 39.7% (870/2191) of patients [ 11 , 12 , 14 , 16 , 22 , 25 – 27 ] and 28.8% of the patients (668/2316) had a previous history of hepatic encephalopathy [ 11 , 13 , 14 , 17 , 18 , 20 – 22 , 24 , 27 ]. In addition, 32.7% (1355/4136) of patients were from Asia [ 14 , 17 , 19 , 21 ] and 1328 patients were candidates for LT during the follow-up period.…”

“…According to the available data, CP and MELD scores were 8.7 and 13.6, respectively. Chronic viral hepatitis (B or C) was the underlying cause of chronic liver disease in 38.5% (521/1358) of patients, HCC was present in 55.5% (260/468) of patients [ 12 , 22 ], while 30.8% (182/591) [ 11 , 13 , 17 , 18 , 20 , 21 ] and 46% (106/230) [ 17 , 21 ] had a previous history of hepatic encephalopathy and variceal bleeding, respectively. In addition, 26% (n = 459) patients were from Asia and 480 (27.1%) patients were candidates for LT.…”

“…In total, 2368 cirrhotic patients had no myosteatosis (mean age 55.5 years, 64% or 949/1484 males, CP score: 6.1 and MELD score: 12.8). Chronic viral hepatitis (B or C) was the underlying cause of chronic liver disease in 47% (765/1628) of patients, 50.4% (182/361) of patients had HCC (12,22) whereas a previous history of hepatic encephalopathy and variceal bleeding was recorded in 13.2% (130/986) [ 11 , 13 , 17 , 18 , 20 , 21 ] and 65% (470/723) [ 17 , 21 ] of patients, respectively. In addition, 37.8% (896/2368) of patients were from Asia, while among the 737 patients with available data, 305 (41%), 360 (49%) and 72 (10%) were classified as CP class A, B and C, respectively [ 11 , 14 , 15 , 17 , 18 , 20 , 22 ] (Suppl.…”

“…These findings were confirmed when we evaluated the studies used the BMI-based definition: 37% (95% CI 22–56%) vs 11% (95% CI 5–23%), respectively, p < 0.01 (only one study used the gender-based definition). Among the studies that evaluated myosteatosis in cirrhotic patients [ 11 – 27 ], only 2 studies provided data regarding the causes of death: Geladari et al [ 13 ] recorded only liver-related deaths in patients with myosteatosis, while in the study by Montano-Loza et al [ 12 ] more frequently sepsis-related deaths and less frequently liver-related deaths were recorded in patients with myosteatosis in comparison to those without (Suppl. Table 1 ).…”