Department of Biomedical Research, Swiss Liver Center, UVCM, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Faculty of Medicine, University of Porto, Porto, Portugal.
Liver Int. 2019 Sep;39(9):1672-1681. doi: 10.1111/liv.14175. Epub 2019 Jul 2.
BACKGROUND & AIMS: In cirrhosis, hepatic venous pressure gradient (HVPG) and imaging body composition assessment can influence prognosis. We assessed whether adipose and skeletal muscle tissues reflect the severity of portal hypertension (PH), and whether they improve non-invasive prediction of decompensation and death.
We included 84 cirrhosis patients with HVPG and computed tomography (CT) within 12 weeks of HVPG at a single centre. L3 vertebra CT images were used for body composition indexes (cm /m ): total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), intramuscular adipose tissue index (IMATI), skeletal muscle index (SMI) and psoas muscle index (PMI). Correlations were calculated between indexes, HVPG and standard non-invasive tests for PH. Twelve-month decompensation and death predictors were determined.
The following were the characteristics for the patients included in the study: male 61%; BMI 28 ± 5 kg/m ; alcoholic liver disease in 51%, non-alcoholic steatohepatitis in 24%; HVPG 14 ± 6 mm Hg; 45% compensated. The median follow-up was 11 (4-17) months. HVPG correlated with SATI (r = -0.282, P = 0.01), TATI (r = -0.220, P = 0.045) and SATI/VATI index (r = -0.240, P = 0.03). In compensated patients, lower VATI (HR 0.94 (0.90-0.99), P = 0.01) was associated with 12-month decompensation. Combining TATI and liver stiffness × spleen size over-platelet count risk score added discriminative capacity for 12-month decompensation (AUROC 0.91 vs 0.87). IMATI was independently associated with mortality in decompensated patients. MELD-Na combined with IMATI discriminated excellently for mortality (AUROC 0.94; P < 0.001).
Hepatic venous pressure gradient inversely correlates with imaging markers of adipose tissue, while markers of sarcopenia were unrelated to PH. In compensated patients, TATI improves non-invasive prediction of decompensation. In decompensated patients, IMATI independently predicted mortality.
在肝硬化中，肝静脉压力梯度（HVPG）和影像学体成分评估可影响预后。我们评估了脂肪组织和骨骼肌组织是否反映门静脉高压（PH）的严重程度，以及它们是否能改善失代偿和死亡的非侵入性预测。
我们纳入了 84 例肝硬化患者，这些患者在 HVPG 测量后 12 周内在单个中心进行了 HVPG 和计算机断层扫描（CT）检查。L3 椎体 CT 图像用于体成分指标（cm/m）：总脂肪组织指数（TATI）、内脏脂肪组织指数（VATI）、皮下脂肪组织指数（SATI）、肌内脂肪组织指数（IMATI）、骨骼肌指数（SMI）和腰大肌指数（PMI）。计算了这些指标与 HVPG 之间的相关性，以及与 PH 的标准非侵入性检查之间的相关性。确定了 12 个月内发生失代偿和死亡的预测因子。
纳入研究的患者特征如下：男性 61%；BMI 28±5kg/m2；酒精性肝病 51%，非酒精性脂肪性肝炎 24%；HVPG 14±6mmHg；45%为代偿。中位随访时间为 11（4-17）个月。HVPG 与 SATI（r=-0.282，P=0.01）、TATI（r=-0.220，P=0.045）和 SATI/VATI 指数（r=-0.240，P=0.03）相关。在代偿患者中，较低的 VATI（HR 0.94（0.90-0.99），P=0.01）与 12 个月内的失代偿相关。将 TATI 和肝硬度×脾脏大小血小板计数比风险评分相结合，增加了 12 个月内失代偿的区分能力（AUROC 0.91 与 0.87）。在失代偿患者中，IMATI 与死亡率独立相关。MELD-Na 联合 IMATI 可极好地区分死亡率（AUROC 0.94；P<0.001）。
HVPG 与脂肪组织影像学标志物呈负相关，而肌少症标志物与 PH 无关。在代偿患者中，TATI 可改善失代偿的非侵入性预测。在失代偿患者中，IMATI 独立预测死亡率。
