The value of different CT‐based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis

Abstract

Background & Aims:Low muscle mass impacts on morbidity and mortality in cirrhosis. The skeletal-muscle index (SMI) is a well-validated tool to diagnose muscle wasting, but requires specialized radiologic software and expertise. Thus, we compared different Computed tomography (CT)-based evaluation methods for muscle wasting and their prognostic value in cirrhosis. Methods:Consecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analysed. SMI, transversal psoas muscle thickness (TPMT), total psoas volume (TPV) and paraspinal muscle index (PSMI) were measured. Sarcopenia was defined using SMI as a reference method by applying sex-specific cut-offs (males: <52.4 cm 2 /m 2 ; females: <38.5 cm 2 /m 2 ). Results:One hundred and nine patients (71.6% male) of age 57 ± 11 years, and alcoholic liver disease (63.3%) as the main aetiology were included. According to established SMI cut-offs, low muscle mass was present in 69 patients (63.3%) who also presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex-specific cut-offs (men/women) for diagnosing low muscle mass were determined: TPMT: <10.7/ <7.8 mm/m, TPV: <194.9/ <99.2 cm 3 and PSMI <26.3/ <20.8 cm 2 /m 2 . Thirty (27.5%) patients died during a follow-up of 15 (0.3-45.7) months. Univariate competing risks analyses showed a significant risk for mortality according to SMI (aSHR:2.52, 95% CI: 1.03-6.21, P = .043), TPMT (aSHR: 3.87, 95% CI: 1.4-8.09, P = .007) and PSMI (aSHR: 2.7, 95% CI: 1.17-6.23, P = .02), but not TPV (P = .18) derived low muscle mass cut-offs. In multivariate analysis only TPMT (aSHR: 2.82, 95% CI: 1.20-6.67, P = .018) was associated with mortality, SMI (aSHR: 1.93, 95% CI: 0.72-5.16, P = .19) and PSMI (aSHR: 1.93, 95% CI: 0.79-4.75, P = .15) were not. Conclusion:Low muscle mass was highly prevalent in our cohort of patients with cirrhosis. Gender-specific TPMT, SMI and PSMI cut-offs for low muscle mass can help identify patients with an increased risk for mortality. Importantly, only TPMT emerged as an independent risk factor for mortality in patients with cirrhosis. K E Y W O R D Scirrhosis, mortality, psoas, sarcopenia, skeletal-muscle index | 2375 PATERNOSTRO ET Al.

MRI‐defined sarcopenia predicts mortality in patients with chronic liver disease

“…Our results indicate that the presence of sarcopenia is not associated with an increased risk for first or further hepatic decompensation. These results are in line with recent findings from our group, suggesting that sarcopenia is not linked to the severity of portal hypertension, 8 which is a main driver of hepatic decompensation. [26][27][28] Conversely, sarcopenia was a strong risk factor for increased mortality, especially in patients with cACLD, in whom it was independently linked to the outcome of interest.…”

“…Our data are in line with previous studies that showed an excellent agreement between CT-and MR-based skeletal muscle index measurements. 21 In contrast to invasive risk assessments, 22 4,8,9,[23][24][25] However, studies that consider the complex natural history of CLD progression, ie that hepatic decompensation usually occurs as initial event, followed by further decompensating events and, ultimately, liver-related mortality, are scare. Our results indicate that the presence of sarcopenia is not associated with an increased risk for first or further hepatic decompensation.…”

“…In addition, the TPMT has been shown to accurately assess sarcopenia in patients with liver disease. 4,8 Paternostro et al recently proposed specific TPMT cut-off values for CT-based measurements at the level of the third lumbar vertebrae which were even more accurate than the SMI in predicting patient survival. 8 Furthermore, it is clinically important to predict hepatic decompensation.…”

“…4,8 Paternostro et al recently proposed specific TPMT cut-off values for CT-based measurements at the level of the third lumbar vertebrae which were even more accurate than the SMI in predicting patient survival. 8 Furthermore, it is clinically important to predict hepatic decompensation. Therefore, we wondered if sarcopenia might be a risk factor for hepatic decompensation, although this has not been systematically assessed.…”

Use of Skeletal Muscle Index as a Predictor of Wait‐List Mortality in Patients With End‐Stage Liver Disease

“…( 17,18 ) Additional studies have examined TPV, PSMI, and TPMT against SMI given its accepted parameters for sarcopenia. ( 19 ) For this reason, this study seeks to validate previously defined cut points for SMI in a different cohort of patients with advanced liver disease.…”