Liver UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.
HPB and Liver Transplant UnitHospital Italiano de Buenos AiresBuenos AiresArgentina.
Hepatol Commun. 2022 Jul;6(7):1699-1710. doi: 10.1002/hep4.1919. Epub 2022 Mar 3.
Sarcopenia is a prevalent condition that predicts prognosis in patients awaiting liver transplantation (LT). The gold standard for the diagnosis of sarcopenia is the assessment of the muscular area at L3 with computed tomography (CT) scan (skeletal muscle index [SMI]), but the routine use of CT scan is limited in clinical practice. Thus, we designed a single-center observational study aimed to evaluate the clinical factors associated with the presence of sarcopenia by SMI, and to build a score capable of predicting or excluding the presence of sarcopenia in patients on the LT waiting list (WL). Binary logistic regression analysis was performed to establish the factors independently associated with sarcopenia, and the Sarcopenia Hospital Italiano de Buenos Aires (HIBA) score was built from the resulting model after internal validation analysis by bootstrapping and correction for optimism. The predictive capability of mortality on the WL was evaluated with competing risk regression analysis. A total of 215 patients with cirrhosis on the LT WL were included. The independent factors associated with the presence of sarcopenia were male sex (odds ratio [OR]: 6.09, p < 0.001), body mass index (OR: 0.74, p < 0.001), Child Pugh (OR: 1.44, p < 0.001), and the ratio creatinine/Cystatin C (OR: 0.03, p = 0.007). The Sarcopenia HIBA score constructed with these variables showed an area under the curve of 0.862. During follow-up, 77 (36%) patients underwent LT, 46 (21%) died, and 92 (43%) remained alive. After adjusting for Model for End-Stage Liver Disease-Sodium, Sarcopenia HIBA score was an independent predictor of WL mortality (subhazard ratio: 1.19; 95% confidence interval 1.01-1.40; p = 0.042). Sarcopenia HIBA score is an easy-to-use, objective, and reliable diagnostic and predictive tool that can be useful to improve the prognostic evaluation and allow identifying a group of patients with a higher risk of death while awaiting LT.
肌肉减少症是一种普遍存在的病症，可预测等待肝移植（LT）的患者的预后。肌肉减少症的金标准诊断方法是使用计算机断层扫描（CT）评估 L3 处的肌肉面积（骨骼肌指数 [SMI]），但 CT 扫描在临床实践中的常规使用受到限制。因此，我们设计了一项单中心观察性研究，旨在评估与 SMI 相关的存在肌肉减少症的临床因素，并构建一个能够预测或排除 LT 等待名单（WL）上患者存在肌肉减少症的评分。进行二元逻辑回归分析以确定与肌肉减少症独立相关的因素，并通过 bootstrap 和校正乐观主义对内部验证分析后，从所得模型中构建阿根廷布宜诺斯艾利斯意大利医院肌肉减少症评分（HIBA）。使用竞争风险回归分析评估 WL 上死亡率的预测能力。共纳入 215 例 LT WL 肝硬化患者。与肌肉减少症存在相关的独立因素为男性（优势比 [OR]：6.09，p < 0.001）、体质指数（OR：0.74，p < 0.001）、Child Pugh 评分（OR：1.44，p < 0.001）和肌酐/胱抑素 C 比值（OR：0.03，p = 0.007）。使用这些变量构建的肌肉减少症 HIBA 评分曲线下面积为 0.862。在随访期间，77 例（36%）患者接受 LT，46 例（21%）死亡，92 例（43%）存活。在调整终末期肝病模型钠后，肌肉减少症 HIBA 评分是 WL 死亡率的独立预测因素（亚危险比：1.19；95%置信区间 1.01-1.40；p = 0.042）。肌肉减少症 HIBA 评分是一种易于使用、客观和可靠的诊断和预测工具，可用于改善预后评估，并确定一组等待 LT 时死亡风险较高的患者。
