Original article—liver, pancreas, and biliary tract
Muscle Wasting Is Associated With Mortality in Patients With Cirrhosis

https://doi.org/10.1016/j.cgh.2011.08.028Get rights and content

Background & Aims

Sarcopenia, defined as a low level of muscle mass, occurs in patients with cirrhosis. We assessed its incidence among cirrhotic patients undergoing evaluation for liver transplantation to investigate associations between sarcopenia and mortality and prognosis.

Methods

We studied 112 patients with cirrhosis (78 men; mean age, 54 ± 1 years) who were consecutively evaluated for liver transplantation and had a computed tomography scan at the level of the third lumbar (L3) vertebrae to determine the L3 skeletal muscle index; sarcopenia was defined by using previously published, sex-specific cutoffs.

Results

Of the patients studied, 45 (40%) had sarcopenia. Univariate Cox analysis associated mortality with ascites (hazard ratio [HR], 2.12; P = .04), encephalopathy (HR, 1.99; P = .04), level of bilirubin (HR, 1.007; P < .01), international normalized ratio (HR, 7.69; P < .001), level of creatinine (HR, 1.01; P = .005), level of albumin (HR, 94; P = .008), serum level of sodium (HR, 89; P < .001), Model for End-Stage Liver Disease (MELD) score (HR, 1.14; P < .01), Child–Pugh score (HR, 2.84; P < .001), and sarcopenia (HR, 2.18; P = .006). By multivariate Cox analysis, only Child–Pugh (HR, 1.85; P = .04) and MELD scores (HR, 1.08; P = .001) and sarcopenia (HR, 2.21; P = .008) were independently associated with mortality. The median survival time for patients with sarcopenia was 19 ± 6 months, compared with 34 ± 11 months among nonsarcopenia patients (P = .005). There was a low level of correlation between L3 skeletal muscle index and MELD (r = −0.07; P = .5) and Child–Pugh scores (r = −0.14; P = .1).

Conclusions

Sarcopenia is associated with mortality in patients with cirrhosis. It does not correlate with the degree of liver dysfunction evaluated by using conventional scoring systems. Scoring systems should include evaluation of sarcopenia to better assess mortality among patients with cirrhosis.

Section snippets

Study Population

One hundred twelve patients with cirrhosis who were consecutively evaluated for liver transplant at the University of Alberta Hospital and who had a computed tomography (CT) scan at the third lumbar (L3) vertebrae were selected. In our center routine diagnostic CT scans are regularly done for diagnosis of hepatocellular carcinoma (HCC) as well as for evaluation of biliary and vascular anatomy in all patients under consideration for liver transplantation.

Clinical and Laboratory Assessments

Data recovered from medical charts

Clinical and Biochemical Features of Patients With Cirrhosis

Seventy-eight patients were men (70%), and the mean age was 54 ± 1 years (median, 54 years; range, 28–71 years). Etiology of liver cirrhosis was hepatitis C virus (HCV) (29%), alcohol (22%), autoimmune liver disease (19%), HCV and alcohol (16%), and others (13%). The remaining clinical and biochemical features are shown in Table 1.

Lumbar Skeletal Muscle Index and Frequency of Sarcopenia in Patients With Cirrhosis

Mean L3 SMI was 51 ± 1 cm2/m2 (median, 50; range, 32–80). Sarcopenia was present in 45 patients (40%). In Figure 1 we compare 2 cirrhotic patients with identical body

Discussion

Our study indicates that sarcopenia is present in approximately 40% of patients with cirrhosis being evaluated for liver transplant, and sarcopenia constitutes a strong and independent predictive factor for mortality. This mortality risk is more than 2-fold higher in sarcopenic than nonsarcopenic patients. Moreover, sarcopenia does not correlate with degree of liver dysfunction evaluated with conventional scores such as Child–Pugh or MELD score and also does not correlate with other common

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    Conflicts of interest The authors disclose no conflicts.

    Funding This study has been awarded a Clinical Research Award from the American College of Gastroenterology Institute (2011).

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