Hou Lijun, Deng You, Wu Huanhuan, Xu Xin, Lin Lin, Cui Binxin, Zhao Tianming, Fan Xiaofei, Mao Lihong, Hou Junjie, Sun Haoran, Wang Bangmao, Sun Chao
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China.
Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin 300052, China.
Ann Transl Med. 2020 Mar;8(6):358. doi: 10.21037/atm.2020.02.49.
To develop a nomogram incorporating indicator of muscle waste to prognosticate long-term mortality in liver cirrhosis (LC), and identify the prognostic impact of psoas muscle index (PMI).
A total of 251 LC patients who underwent computed tomography were included in this study. Multiple Cox regression was performed, and sex-specific nomogram models incorporating PMI were developed. The utility of the proposed models were evaluated by Harrell's concordance index (C-index), calibration curve and decision curve analysis. X-tile was used to determine optimal cutpoint for stratifying subjects with distinct outcomes. Subgroup analysis was implemented in terms of age and MELD score. The correlation between PMI and gait speed was also evaluated.
On multiple analysis, independent predictors for 3-year all-cause mortality were age, BMI, PMI and MELD for males, and age, PMI and MELD for females. Both nomogram models gave rise to moderately strong discrimination, with a C-index of 0.792 (95% CI: 0.723-0.861) in males and 0.715 (95% CI: 0.637-0.793) in females, respectively. The calibration curve implied predicted survival corresponding optimally with the actual outcomes. The proposed models were feasible in clinical settings based on decision curve analysis. On subgroup analysis, PMI might confer valid predictive value on LC patients with MELD <15. Moreover, a definitely positive correlation between PMI and gait speed was revealed.
Our proposed nomogram embedding PMI rendered an individualized predictive tool for long-term mortality in LC. The diminishing value of PMI is likely indicative of muscle dysfunction.
开发一种纳入肌肉消瘦指标的列线图，以预测肝硬化（LC）患者的长期死亡率，并确定腰大肌指数（PMI）的预后影响。
本研究纳入了251例接受计算机断层扫描的LC患者。进行多因素Cox回归分析，并建立了纳入PMI的性别特异性列线图模型。通过Harrell一致性指数（C指数）、校准曲线和决策曲线分析评估所提出模型的效用。使用X-tile软件确定用于分层不同结局受试者的最佳切点。根据年龄和终末期肝病模型（MELD）评分进行亚组分析。还评估了PMI与步速之间的相关性。
多因素分析显示，男性3年全因死亡率的独立预测因素为年龄、体重指数（BMI）、PMI和MELD，女性为年龄、PMI和MELD。两个列线图模型均具有中等强度的区分能力，男性的C指数为0.792（95%CI：0.723-0.861），女性为0.715（95%CI：0.637-0.793）。校准曲线表明预测生存率与实际结局最佳对应。基于决策曲线分析，所提出的模型在临床环境中是可行的。亚组分析显示，PMI可能对MELD<15的LC患者具有有效的预测价值。此外，还揭示了PMI与步速之间存在显著正相关。
我们提出的纳入PMI的列线图为LC患者的长期死亡率提供了一种个体化预测工具。PMI值的降低可能表明肌肉功能障碍。
