Benmassaoud Amine, Roccarina Davide, Arico Francesco Marcello, Cilla Marta, Donghia Rossella, Leandro Gioacchino, Prat Laura Iogna, Zuhair Mohamed, North Matthew, Kearney Orla, Ryan John, Tsochatzis Emmanuel A
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada.
The Royal Free Sheila Sherlock Liver Centre, Royal Free London NHS Trust, London, UK.
Liver Int. 2023 Jan;43(1):160-169. doi: 10.1111/liv.15293. Epub 2022 May 25.
Body composition predicts mortality in patients with cirrhosis. The impact of sex on this association is unknown. We investigated the impact of sex on this association in patients with cirrhosis assessed for liver transplantation.
This single-centre retrospective cohort study included adults assessed for liver transplantation. Nutritional status was assessed using the Royal Free Hospital-Global Assessment (RFH-GA). Body composition at the third lumbar vertebrae was determined. Sarcopenia was defined as Skeletal Muscle Index <50 cm /m in males and <39 cm /m in females. Sarcopenia was defined as the sex-specific 25th percentile of the Psoas Muscle Index. Patients were assessed for the occurrence of liver transplantation and death. Analyses were stratified by sex.
The cohort comprised 628 patients, including 199 females and 429 males. Both groups were similar in terms of baseline liver disease severity by Model for End-stage Liver Disease (MELD) (p = .98) and nutritional status (p = .24). Sarcopenia was present in 41% of males compared to 27% of females (p < .001). In the male cohort, when adjusted for age and MELD, sarcopenia (aHR 1.74, 95% CI 1.08-2.80) and RFH-GA (aHR 1.40, 95% CI 1.03-1.90) remained independent predictors of mortality. Adipose tissue had no impact on outcomes in males. In female patients, adipose tissue (TATI or VATI depending on the multivariable model) was independently associated with mortality, whereas sarcopenia and malnutrition were not.
This study demonstrates that male patients were susceptible to low muscle mass, whereas female patients were not. Future research in this patient population should minimize sex-related bias and present data for both groups separately.
身体组成可预测肝硬化患者的死亡率。性别对这种关联的影响尚不清楚。我们调查了性别对接受肝移植评估的肝硬化患者中这种关联的影响。
这项单中心回顾性队列研究纳入了接受肝移植评估的成年人。使用皇家自由医院全球评估法（RFH-GA）评估营养状况。测定第三腰椎水平的身体组成。肌肉减少症定义为男性骨骼肌指数<50 cm²/m²，女性<39 cm²/m²。肌肉减少症定义为腰大肌指数的性别特异性第25百分位数。评估患者肝移植和死亡的发生情况。分析按性别分层。
该队列包括628例患者，其中女性199例，男性429例。两组在终末期肝病模型（MELD）评估的基线肝病严重程度（p = 0.98）和营养状况（p = 0.24）方面相似。41%的男性存在肌肉减少症，而女性为27%（p < 0.001）。在男性队列中，调整年龄和MELD后，肌肉减少症（校正风险比1.74，95%置信区间1.08 - 2.80）和RFH-GA（校正风险比1.40，95%置信区间1.03 - 1.90）仍然是死亡率的独立预测因素。脂肪组织对男性的预后无影响。在女性患者中，脂肪组织（根据多变量模型为TATI或VATI）与死亡率独立相关，而肌肉减少症和营养不良则不然。
本研究表明男性患者易患低肌肉量，而女性患者则不然。该患者群体的未来研究应尽量减少性别相关偏倚，并分别呈现两组的数据。
