Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, California, USA.
Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.
Liver Transpl. 2023 May 1;29(5):476-484. doi: 10.1097/LVT.0000000000000010. Epub 2023 Jan 3.
Sarcopenic obesity is associated with higher rates of morbidity and mortality than seen with either sarcopenia or obesity alone. We aimed to define sarcopenic visceral obesity (SVO) using CT-quantified skeletal muscle index and visceral-to-subcutaneous adipose tissue ratio and to examine its association with waitlist mortality in patients with cirrhosis. Included were 326 adults with cirrhosis awaiting liver transplantation in the ambulatory setting with available abdominal CT within 6 months from enrollment between February 2015 and January 2018. SVO was defined as patients with sarcopenia (skeletal muscle index <50 cm 2 /m 2 in men and <39 cm 2 /m 2 in women) and visceral obesity (visceral-to-subcutaneous adipose tissue ratio ≥1.21 in men and ≥0.48 in women). The percentage who met criteria for sarcopenia, visceral obesity, and SVO were 44%, 29%, and 13%, respectively. Cumulative incidence of waitlist mortality was higher in patients with SVO compared to patients with sarcopenia without visceral obesity or visceral obesity without sarcopenia at 12 months (40% vs. 21% vs. 12%) (overall logrank p =0.003). In univariable Cox regression, SVO was associated with waitlist mortality (HR: 3.42, 95% CI: 1.58-7.39), which remained significant after adjusting for age, sex, diabetes, ascites, encephalopathy, MELDNa, liver frailty index, and different body compositions (HR: 2.64, 95% CI: 1.11-6.30). SVO was associated with increase waitlist mortality in patients with cirrhosis in the ambulatory setting awaiting liver transplantation. Concurrent loss of skeletal muscle and gain of adipose tissue seen in SVO quantified by CT may be a useful and objective measurement to identify patients at risk for suboptimal pretransplant outcomes.
肌少型肥胖与发病率和死亡率的相关性高于单纯肌少症或肥胖症。我们旨在使用 CT 定量骨骼肌指数和内脏到皮下脂肪组织比来定义肌少型内脏肥胖（SVO），并研究其与等待肝移植的肝硬化患者的等待期死亡率之间的关系。纳入了 2015 年 2 月至 2018 年 1 月期间在门诊接受等待肝移植的肝硬化成年人 326 例，这些患者在登记后 6 个月内均有可用的腹部 CT。SVO 定义为肌少症（男性骨骼肌指数＜50cm 2 /m 2 ，女性＜39cm 2 /m 2 ）和内脏肥胖症（男性内脏到皮下脂肪组织比≥1.21，女性≥0.48）患者。符合肌少症、内脏肥胖症和 SVO 标准的患者百分比分别为 44%、29%和 13%。SVO 患者的等待期死亡率在 12 个月时高于仅有肌少症而无内脏肥胖症或仅有内脏肥胖症而无肌少症的患者（40%比 21%比 12%）（总体对数秩检验 p =0.003）。在单变量 Cox 回归中，SVO 与等待期死亡率相关（HR：3.42，95%CI：1.58-7.39），在调整年龄、性别、糖尿病、腹水、肝性脑病、MELDNa、肝脏脆弱指数和不同身体成分后，该相关性仍然显著（HR：2.64，95%CI：1.11-6.30）。SVO 与门诊等待肝移植的肝硬化患者的等待期死亡率增加相关。SVO 通过 CT 定量检测到的骨骼肌丢失和脂肪组织增加，可能是识别移植前结局不理想风险患者的有用且客观的测量方法。
