Wang Chuhan, Teng Yue, Gao Jin, Zhang Zichen, Li Yonggang
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, People's Republic of China.
State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, 215123, China.
Abdom Radiol (NY). 2023 Apr;48(4):1454-1467. doi: 10.1007/s00261-023-03813-4. Epub 2023 Feb 3.
We aimed to investigate the predictive value of body compositions measured by CT, including skeletal muscle and adipose tissue, for hepatic encephalopathy (HE) in cirrhotic patients following transjugular intrahepatic portosystemic shunt (TIPS).
Patients who underwent TIPS between November 2015 and April 2021 were included in this retrospective study. CT images taken at L3 were quantified for three body composition indexes (cm/m), visceral fat area index (VFAI), subcutaneous fat area index (SFAI), and skeletal muscle index (SMI) at baseline. Multivariable logistic regression models were conducted to assess associations between post-TIPS HE and body compositions. Nomograms based on the multivariable logistic regression models were developed and were evaluated from Calibration curves.
Male patients had greater SMI, whereas SFAI and VFAI were higher in females (p < 0.001 for each). In sex stratified multivariate analyses after adjustment for other confounding variables, VFAI in males (p = 0.033) and SFAI in females (p = 0.003) were significant predictors of post-TIPS HE. Male patients with low VFAI (< 53.52 cm/m) (OR 6.44; 95% CI 1.72-23.59; p = 0.006) and female patients with low SFAI (< 70.05 cm/m) (OR 10.55; 95% CI 2.36-46.23; p = 0.002) had a higher risk of post-TIPS HE. Risk factors in the nomogram contributing to the male model included age, height, Child-Pugh score, and low VFAI; pre-albumin and low SFAI were contributed to female model.
Body compositions could not only be noninvasively used for nutritional assessment, but also be utilized to predict HE risk of cirrhotic patients after TIPS.
我们旨在研究通过CT测量的身体成分，包括骨骼肌和脂肪组织，对经颈静脉肝内门体分流术（TIPS）后肝硬化患者肝性脑病（HE）的预测价值。
本回顾性研究纳入了2015年11月至2021年4月期间接受TIPS的患者。在基线时，对L3水平的CT图像进行量化，以获取三个身体成分指标（厘米/米），即内脏脂肪面积指数（VFAI）、皮下脂肪面积指数（SFAI）和骨骼肌指数（SMI）。采用多变量逻辑回归模型评估TIPS后HE与身体成分之间的关联。基于多变量逻辑回归模型绘制列线图，并通过校准曲线进行评估。
男性患者的SMI更高，而女性患者的SFAI和VFAI更高（每项p < 0.001）。在对其他混杂变量进行调整后的性别分层多变量分析中，男性的VFAI（p = 0.033）和女性的SFAI（p = 0.003）是TIPS后HE的显著预测因素。VFAI低（< 53.52厘米/米）的男性患者（OR 6.44；95% CI 1.72 - 23.59；p = 0.006）和SFAI低（< 70.05厘米/米）的女性患者（OR 10.55；95% CI 2.36 - 46.23；p = 0.002）发生TIPS后HE的风险更高。列线图中对男性模型有影响的危险因素包括年龄、身高、Child-Pugh评分和低VFAI；前白蛋白和低SFAI对女性模型有影响。
身体成分不仅可用于无创营养评估，还可用于预测肝硬化患者TIPS后发生HE的风险。
