Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Cachexia Sarcopenia Muscle. 2018 Oct;9(5):860-870. doi: 10.1002/jcsm.12333.
Sarcopenia has been reported as a prognostic factor. We evaluated the impact of sarcopenia to the conventional prognostic factors [Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, hepatic venous pressure gradient (HVPG)] in cirrhosis.
Overall, 452 patients with cirrhosis were stratified by MELD score (low < 15, high ≥ 15), CTP class, and HVPG [non-clinically significant portal hypertension (CSPH), 6-9 mmHg; CSPH, 10-19 mmHg; extremely severe PH, ≥20 mmHg]. L3 skeletal muscle index as marker of sarcopenia was subdivided into quartiles (47.01-52.25-58.22 cm /m ).
Among the patients, 42% (190/452) presented with sarcopenia. During a median follow-up period of 21.2 months, sarcopenia was associated with mortality (adjusted hazard ratio = 2.253, P < 0.001) and specifically with compensated and early decompensated stages of cirrhosis, but not with advanced decompensated stages; low (P < 0.001) and high (P = 0.095) MELD scores; CTP classes A (P = 0.034), B (P < 0.001), and C (P = 0.205); and non-CSPH (P = 0.018), CSPH (P < 0.001), and extremely severe PH (P = 0.846). In quartiles of sarcopenia, MELD score, CTP class, and HVPG were independent predictors of mortality in non-sarcopenia, but not in severe sarcopenia (MELD, P = 0.182; CTP, P = 0.187; HVPG, P = 0.077).
Sarcopenia is associated with mortality in compensated and early decompensated cirrhosis, and existing conventional prognostic factors had limited value in severe sarcopenia. Therefore, incorporating sarcopenia in the conventional prognostic factors had added value, particularly in compensated and early decompensated cirrhosis. Subclassification of prognostic factors according to sarcopenia may help to better assess the prognosis of cirrhosis.
肌肉减少症已被报道为一种预后因素。我们评估了肌肉减少症对肝硬化的常规预后因素（终末期肝病模型评分[MELD]、Child-Turcotte-Pugh [CTP]评分、肝静脉压力梯度[HVPG]）的影响。
总体而言，根据 MELD 评分（低 < 15，高≥ 15）、CTP 分级和 HVPG [非临床显著门静脉高压（CSPH），6-9mmHg；CSPH，10-19mmHg；极重度 PH，≥20mmHg]将 452 例肝硬化患者分层。作为肌肉减少症标志物的 L3 骨骼肌指数分为四分位数（47.01-52.25-58.22cm/m）。
在这些患者中，42%（190/452）存在肌肉减少症。在中位随访 21.2 个月期间，肌肉减少症与死亡率相关（校正后的危险比=2.253，P<0.001），特别是与代偿期和早期失代偿期肝硬化相关，但与晚期失代偿期肝硬化无关；低（P<0.001）和高（P=0.095）MELD 评分；CTP 分级 A（P=0.034）、B（P<0.001）和 C（P=0.205）；非 CSPH（P=0.018）、CSPH（P<0.001）和极重度 PH（P=0.846）。在肌肉减少症四分位数中，MELD 评分、CTP 分级和 HVPG 是非肌肉减少症患者死亡的独立预测因素，但不是严重肌肉减少症患者的独立预测因素（MELD，P=0.182；CTP，P=0.187；HVPG，P=0.077）。
肌肉减少症与代偿期和早期失代偿期肝硬化的死亡率相关，而现有的常规预后因素在严重肌肉减少症中的价值有限。因此，将肌肉减少症纳入常规预后因素具有附加价值，尤其是在代偿期和早期失代偿期肝硬化中。根据肌肉减少症对预后因素进行分类可能有助于更好地评估肝硬化的预后。
