Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China.
Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China.
Clin Nutr. 2020 Jun;39(6):1908-1913. doi: 10.1016/j.clnu.2019.08.006. Epub 2019 Aug 15.
BACKGROUND & AIMS: The objective nutritional assessment indicators, body mass index (BMI), upper arm muscle circumference (MAMC), and triceps skinfold thickness (TSF), are often limited due to ascites. This study investigated the prognostic value of the third lumbar vertebrae skeletal muscle mass index (L3 SMI) in addition to the objective nutritional evaluation indicators (BMI, MAMC and TSF) in patients with liver cirrhosis and ascites.
In this retrospective analysis, a total of 147 patients with liver cirrhosis and ascites were included. The L3 SMI, BMI, MAMC and TSF were detected in all patients. The severity of liver disease was assessed by the Model End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) classification. These variables were compared between non-surviving and surviving patients who were classified according to 5-year mortality.
Of the 147 patients, 62 (42.2%) died and 85 (57.8%) survived within 5 years. The L3 SMI of patients was significantly lower than that of the normal control group (39.58 ± 7.18 cm/m vs. 53.73 ± 7.92 cm/m,p < 0.001). The L3 SMI (OR 4.02; 95% CI 2.17-9.63; p < 0.001), MELD score (OR 2.11; 95% CI 1.12-4.13; p < 0.001) and CTP class (OR 2.69; 95% CI 1.09-5.06; p < 0.001) were independent predictive indicators of 5-year mortality. Furthermore, the performance of the two variables (L3 SMI and MELD) together (AUROC: 0.812) was significantly better than that of MELD alone (AUROC: 0.787) for prediction of 5-year mortality (p < 0.001).
Compared with MAMC, TSF and BMI, L3 SMI is an independent risk factor for 5-year mortality in patients with liver cirrhosis and ascites. Further nutritional intervention studies are needed to confirm the impact of the L3 SMI index on clinical outcomes.
由于腹水的存在，身体质量指数（BMI）、上臂肌围（MAMC）和三头肌皮褶厚度（TSF）等客观营养评估指标往往受到限制。本研究旨在探讨除客观营养评估指标（BMI、MAMC 和 TSF）外，第三腰椎骨骼肌肉质量指数（L3 SMI）在肝硬化伴腹水患者中的预后价值。
本回顾性分析共纳入 147 例肝硬化伴腹水患者。所有患者均检测 L3 SMI、BMI、MAMC 和 TSF。采用终末期肝病模型评分（MELD）和 Child-Turcotte-Pugh（CTP）分级评估肝功能严重程度。根据 5 年死亡率，将患者分为非生存组和生存组，并对这些变量进行比较。
147 例患者中，62 例（42.2%）死亡，85 例（57.8%）在 5 年内存活。患者的 L3 SMI 明显低于正常对照组（39.58±7.18cm/m 比 53.73±7.92cm/m，p<0.001）。L3 SMI（OR 4.02；95%CI 2.17-9.63；p<0.001）、MELD 评分（OR 2.11；95%CI 1.12-4.13；p<0.001）和 CTP 分级（OR 2.69；95%CI 1.09-5.06；p<0.001）是 5 年死亡率的独立预测指标。此外，与 MELD 评分相比，L3 SMI 和 MELD 评分（AUROC：0.812）联合检测（AUROC：0.812）对 5 年死亡率的预测性能显著更好（p<0.001）。
与 MAMC、TSF 和 BMI 相比，L3 SMI 是肝硬化伴腹水患者 5 年死亡率的独立危险因素。需要进一步的营养干预研究来证实 L3 SMI 指数对临床结局的影响。
