Nishikawa Hiroki, Yoh Kazunori, Enomoto Hirayuki, Nishimura Takashi, Nishiguchi Shuhei, Iijima Hiroko
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Ann Transl Med. 2021 Apr;9(8):624. doi: 10.21037/atm-20-6901.
Sarcopenia and body composition can be associated with mortality in chronic liver diseases (CLDs). We sought to identify predictors in CLD patients (n=631, 309 males) and create a prognostic model using easily available indexes.
Reference values for low-grip strength (GS) were 26 kg in men and 18 kg in women. Reference values for low-skeletal muscle index (SMI) were 7.0 kg/m in men and 5.7 kg/m in women using bioelectrical impedance analysis (BIA). Reference values for low-calf circumference (CC) were 34 cm in men and 33 cm in women. Reference values for high-waist circumference were 85 cm in men and 90 cm in women. Using significant factors in the multivariate analysis contributing to the overall survival (OS), we created a simple predictive model. Akaike information criterion (AIC) was compared.
Men (P<0.0001), presence of liver cirrhosis (LC) (P<0.0001), presence of hepatocellular carcinoma (HCC) (P<0.0001), low-GS (P<0.0001), low-CC (P<0.0001), serum albumin (P=0.0355), estimated glomerular filtration rate (P=0.0461), hepatitis B virus (P=0.0044) and hepatitis C virus (P<0.0001) were significant factors contributing to the OS by the multivariate analysis. The study subjects were classified into the 4 groups (combined GS-SMI system): (I) low-GS and low-SMI (sarcopenia, n=73); (II) low-GS and high-SMI (n=65); (III) high-GS and low-SMI (n=110); and (IV) high-GS and high-SMI (n=383). The cumulative OS rates were well stratified among 4 groups (overall P<0.0001, AIC =360.895). The study subjects were also classified into the 4 groups (combined GS-CC system): (I) low-GS and low-CC (n=60); (II) low-GS and high-CC (n=78); (III) high-GS and low-CC (n=70); and (IV) high-GS and high-CC (n=423). The cumulative OS rates were also well stratified among 4 groups (overall P<0.0001, AIC =349.521). In receiver operating characteristic (ROC) curve analysis for CC based on the OS, the optimal cutoff point in men was 34.6 cm [area under the ROC (AUC) =0.70, sensitivity =0.558, specificity =0.842], and that in women was 32.8 cm (AUC =0.72, sensitivity =0.619, specificity =0.787).
CC can be an alternative marker for muscle mass in CLD patients. Our proposed combined GS-CC system can be helpful in the community settings without special equipment for muscle mass measurement.
肌肉减少症和身体组成可能与慢性肝病（CLD）患者的死亡率相关。我们试图确定CLD患者（n = 631，309名男性）的预测因素，并使用易于获得的指标创建一个预后模型。
男性低握力（GS）的参考值为26千克，女性为18千克。使用生物电阻抗分析（BIA），男性低骨骼肌指数（SMI）的参考值为7.0千克/米，女性为5.7千克/米。男性低小腿围（CC）的参考值为34厘米，女性为33厘米。男性高腰围的参考值为85厘米，女性为90厘米。利用多变量分析中对总生存期（OS）有影响的显著因素，我们创建了一个简单的预测模型。比较了赤池信息准则（AIC）。
男性（P<0.0001）、肝硬化（LC）的存在（P<0.0001）、肝细胞癌（HCC）的存在（P<0.0001）、低GS（P<0.0001）、低CC（P<0.0001）、血清白蛋白（P = 0.0355）、估计肾小球滤过率（P = 0.0461）、乙型肝炎病毒（P = 0.0044）和丙型肝炎病毒（P<0.0001）是多变量分析中对OS有显著影响的因素。研究对象被分为4组（联合GS-SMI系统）：（I）低GS和低SMI（肌肉减少症，n = 73）；（II）低GS和高SMI（n = 65）；（III）高GS和低SMI（n = 110）；以及（IV）高GS和高SMI（n = 383）。4组之间的累积OS率有良好的分层（总体P<0.0001，AIC = 360.895）。研究对象也被分为4组（联合GS-CC系统）：（I）低GS和低CC（n = 60）；（II）低GS和高CC（n = 78）；（III）高GS和低CC（n = 70）；以及（IV）高GS和高CC（n = 423）。4组之间的累积OS率也有良好的分层（总体P<0.0001，AIC = 349.521）。在基于OS的CC的受试者工作特征（ROC）曲线分析中，男性的最佳截断点为34.6厘米[ROC曲线下面积（AUC）= 0.70，灵敏度 = 0.558，特异性 = 0.842]，女性为32.8厘米（AUC = 0.72，灵敏度 = 0.619，特异性 = 0.787）。
CC可以作为CLD患者肌肉量的替代标志物。我们提出的联合GS-CC系统在没有测量肌肉量的特殊设备的社区环境中可能会有所帮助。
