Matsui Teppei, Nagai Hidenari, Watanabe Gou, Mouri Kunihide, Yoshimine Naoyuki, Amanuma Makoto, Kobayashi Kojirou, Ogino Yu, Mukozu Takanori, Matsukiyo Yasushi, Daidou Yasuko, Wakui Noritaka, Nakano Shigeru, Momiyama Koichi, Matsuda Takahisa, Igarashi Yoshinori
Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo.
Division of Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
Eur J Gastroenterol Hepatol. 2022 Nov 1;34(11):1151-1157. doi: 10.1097/MEG.0000000000002435. Epub 2022 Sep 28.
Hepatic venous pressure gradient (HVPG) and the model for end-stage liver disease (MELD) score were previously reported as prognostic factors for outcome in patients with liver cirrhosis (LC), and recently, the presence of sarcopenia was reported to be an indicator of worse prognosis in these patients.
This retrospective study aimed to clarify the importance of sarcopenia as a prognostic factor in patients with LC.
The MELD-Na score, HVPG, and skeletal muscle index (SMI) were measured in 202 patients between January 2013 and August 2020. We performed linear regression analysis between HVPG and SMI and calculated suitable cutoff values of HVPG for predicting presarcopenia and of HVPG, ΔSMI (i.e. the decrease in SMI per year, for predicting survival). Overall survival rates with the HVPG and ΔSMI cutoff values were compared by Kaplan-Meier estimates and log-rank tests. Prognostic factors for survival were analyzed by Cox regression univariate and multivariate analyses.
In total, 71% (143/202) of patients presented with presarcopenia. Linear regression showed a significantly negative correlation between HVPG and SMI. Survival was significantly worse in the group with presarcopenia than in the group without. Survival was worse also in the group with an HVPG value ≥ 15 and ΔSMI ≥ -2.4. Cox regression multivariate analyses showed that MELD-Na score, HVPG, HVPG ≥ 15, ΔSMI, and ΔSMI ≥ -2.4 were independent prognostic factors.
Skeletal muscle volume, especially ΔSMI, has a prognostic value equivalent to that of the MELD-Na score and HVPG.
肝静脉压力梯度（HVPG）和终末期肝病模型（MELD）评分先前被报道为肝硬化（LC）患者预后的预测因素，最近，肌肉减少症的存在被报道为这些患者预后较差的指标。
这项回顾性研究旨在阐明肌肉减少症作为LC患者预后预测因素的重要性。
在2013年1月至2020年8月期间对202例患者测量了MELD-Na评分、HVPG和骨骼肌指数（SMI）。我们对HVPG和SMI进行了线性回归分析，并计算了用于预测肌肉减少症前期的HVPG合适截断值以及用于预测生存的HVPG、ΔSMI（即每年SMI的下降值）的合适截断值。通过Kaplan-Meier估计和对数秩检验比较了具有HVPG和ΔSMI截断值的总生存率。通过Cox回归单因素和多因素分析来分析生存的预测因素。
总共71%（143/202）的患者存在肌肉减少症前期。线性回归显示HVPG与SMI之间存在显著负相关。肌肉减少症前期组的生存情况明显比无肌肉减少症前期组差。HVPG值≥15且ΔSMI≥-2.4的组生存情况也较差。Cox回归多因素分析显示MELD-Na评分、HVPG、HVPG≥15、ΔSMI以及ΔSMI≥-2.4是独立的预后因素。
骨骼肌体积，尤其是ΔSMI，具有与MELD-Na评分和HVPG相当的预后价值。
