Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
Am J Transplant. 2020 Feb;20(2):493-503. doi: 10.1111/ajt.15577. Epub 2019 Sep 18.
Muscle wasting and alterations of body composition are linked to clinical outcomes in numerous medical conditions. The role of myosteatosis in posttransplant outcomes remains to be determined. Here we investigated skeletal muscle mass and myosteatosis as prognostic factors in patients undergoing orthotopic liver transplantation (OLT). The data of 225 consecutive OLT recipients from a prospective database were retrospectively analyzed (May 2010-December 2017). Computed tomography-based skeletal-muscle-index (muscle mass), visceral-fat-area (visceral adiposity), and mean skeletal-muscle-radiation-attenuation (myosteatosis) were calculated using a segmentation tool. Cut-off values of myosteatosis resulted in a good stratification of patients into low- and high-risk groups in terms of morbidity (Clavien-Dindo ≥3b). Patients with myosteatosis had significantly higher complication rates (90-day Comprehensive Complication Index 68 ± 32 vs 44 ± 30, P < .001) and also displayed significantly longer intensive care (18 ± 25 vs 11 ± 21 days, P < .001) and hospital stay (56 ± 55 vs 33 ± 24 days, P < .001). Estimated costs were 44% higher compared to patients without myosteatosis. Multivariable analysis identified myosteatosis as an independent prognostic factor for major morbidity (odds ratio: 2.772, confidence interval: 1.516-5.066, P = .001). Adding myosteatosis to the well-established Balance-of-Risk-(BAR) score resulted in an increased prognostic value compared to the original BAR score. Myosteatosis may be a useful parameter to predict perioperative outcome in patients undergoing OLT, supporting the role of muscle quality (myosteatosis) over quantity (muscle mass) in this setting.
肌肉减少和身体成分改变与许多医学病症的临床结果有关。脂肪浸润在移植后结果中的作用仍有待确定。在这里，我们研究了肌肉质量和脂肪浸润作为接受原位肝移植（OLT）患者的预后因素。回顾性分析了 2010 年 5 月至 2017 年 12 月期间从一个前瞻性数据库中连续 225 例 OLT 受者的数据。使用分割工具基于计算机断层扫描计算骨骼肌指数（肌肉质量）、内脏脂肪面积（内脏肥胖）和平均骨骼肌辐射衰减（脂肪浸润）。脂肪浸润的截止值导致患者在发病率方面（Clavien-Dindo ≥3b）分为低风险和高风险组。患有脂肪浸润的患者并发症发生率明显较高（90 天综合并发症指数为 68±32 比 44±30，P<.001），且 ICU 时间（18±25 比 11±21 天，P<.001）和住院时间（56±55 比 33±24 天，P<.001）也明显延长。与无脂肪浸润的患者相比，估计费用高出 44%。多变量分析确定脂肪浸润是主要发病率的独立预后因素（比值比：2.772，置信区间：1.516-5.066，P=.001）。将脂肪浸润添加到既定的风险平衡（BAR）评分中，与原始 BAR 评分相比，预后价值增加。脂肪浸润可能是预测 OLT 患者围手术期结果的有用参数，支持肌肉质量（脂肪浸润）而不是数量（肌肉质量）在这种情况下的作用。
