Kim Tae Yeob, Kim Min Yeong, Sohn Joo Hyun, Kim Sun Min, Ryu Jeong Ah, Lim Sanghyeok, Kim Youngsoo
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University, Guri, Korea.
Department of Radiology, Hanyang University Guri Hospital, Hanyang University, Guri, Korea.
J Korean Med Sci. 2014 Sep;29(9):1253-9. doi: 10.3346/jkms.2014.29.9.1253. Epub 2014 Sep 2.
This study aimed to assess and compare sarcopenia with other prognostic factors for predicting long-term mortality in cirrhotic patients with ascites. Clinical data of 65 among 89 patients with measurement of all parameters were consecutively collected. Sarcopenia was evaluated as right psoas muscle thickness measurement divided by height (PMTH) (mm/m). During a mean follow-up of 20 (range: 1-49) months, 19 (29.2%) of 65 patients died. The values of the area under the receiver operating characteristics curve (AUROC) of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na, and PMTH for predicting 1-yr mortality were 0.777 (95% CI, 0.635-0.883), 0.769 (95% CI, 0.627-0.877), 0.800 (95% CI, 0.661-0.900), and 0.833 (95% CI, 0.699-0.924), whereas hepatic venous pressure gradient was not significant (AUROC, 0.695; 95% CI. 0.547-0.818, P=0.053). The differences between PMTH and other prognostic variables were not significant (all P>0.05). The best cut-off value of PMTH to predict long-term mortality was 14 mm/m. The mortality rates at 1-yr and 2-yr with PMTH>14 mm/m vs. PMTH≤14 mm/m were 2.6% and 15.2% vs. 41.6% and 66.8%, respectively (P<0.001). The mortality in cirrhotic patients with PMTH≤14 mm/m was higher than those with PMTH>14 mm/m (HR, 5.398; 95% CI, 2.111-13.800, P<0.001). In conclusion, sarcopenia, evaluated by PMTH, is an independent useful predictor for long-term mortality in cirrhotic patients with ascites.
本研究旨在评估肌肉减少症，并将其与其他预后因素进行比较，以预测肝硬化腹水患者的长期死亡率。连续收集了89例患者中65例测量了所有参数的临床数据。肌肉减少症通过右腰大肌厚度测量值除以身高（PMTH）（mm/m）来评估。在平均20（范围：1 - 49）个月的随访期间，65例患者中有19例（29.2%）死亡。Child-Pugh评分、终末期肝病模型（MELD）评分、MELD-Na和PMTH预测1年死亡率的受试者工作特征曲线下面积（AUROC）值分别为0.777（95%CI，0.635 - 0.883）、0.769（95%CI，0.627 - 0.877）、0.800（95%CI，0.661 - 0.900）和0.833（95%CI，0.699 - 0.924），而肝静脉压力梯度无显著意义（AUROC，0.695；95%CI. 0.547 - 0.818，P = 0.053）。PMTH与其他预后变量之间的差异无统计学意义（所有P>0.05）。预测长期死亡率的PMTH最佳截断值为14 mm/m。PMTH>14 mm/m与PMTH≤14 mm/m时1年和2年的死亡率分别为2.6%和15.2%，以及41.6%和66.8%（P<0.001）。PMTH≤14 mm/m的肝硬化患者死亡率高于PMTH>14 mm/m的患者（HR，5.398；95%CI，2.111 - 13.800，P<0.001）。总之，通过PMTH评估的肌肉减少症是肝硬化腹水患者长期死亡率的一个独立有用的预测指标。
