Thyloor Kenchappa Surakshith, Sharma Samarth, Kumar Mandhir, Ghuman Samarjit S, Arora Anil, Ranjan Piyush
Institute of Liver, Gastroenterology, and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India.
Department of Radio-diagnosis, Sir Ganga Ram Hospital, New Delhi, India.
J Clin Exp Hepatol. 2023 Nov-Dec;13(6):946-954. doi: 10.1016/j.jceh.2023.05.001. Epub 2023 May 10.
Sarcopenia is common in chronic advanced liver disease and is associated with poor prognosis. There is paucity of Indian data regarding sarcopenia in chronic advanced liver disease & its impact on prognosis. The aim of this study was to study the prevalence of sarcopenia in Indian patients with chronic advanced liver disease and its impact on morbidity and short-term mortality.
Patients with chronic advanced liver disease were prospectively evaluated for the presence of sarcopenia using computerized tomography (CT) abdomen. The cross-sectional area of the right psoas muscle was measured at the third lumbar vertebra (L3) and the Psoas muscle index (PMI) was calculated. Sarcopenia was defined as PMI <295 mm/m for females and <356 mm/m for males. The normative values of PMI were obtained from patients undergoing CT scan for non-specific abdominal pain who had no confounding factor which could result in sarcopenia. All patients were followed up for 6 months or until death, whichever was earlier. The impact of sarcopenia on mortality and rate of readmission has been assessed at the end of 6 months.
Of the 156 patients with chronic advanced liver disease, 74 (47.4%) patients had sarcopenia. Sarcopenia was more commonly seen in males (M: F = 61:13) and in patients with alcohol-related liver disease. There was a linear correlation (negative) between the PMI and severity of liver disease as assessed by Child-Pugh and model for end-stage liver disease (MELD) scores (r = -0.591 and -0.465, respectively). Patients with encephalopathy, ascites, and coagulopathy had higher prevalence of sarcopenia. On six months follow-up, sarcopenic patients had higher readmission rates (74.3% vs. 22%; = 0.0001) and higher mortality (24.3% vs. 3.7%; = 0.002). MELD score and PMI were independent predictors of mortality. The cut-off value of PMI 305.9 mm/m predicted mortality with a sensitivity of 76.2% and a false positivity of 22.2% (area under curve was 0.805; 95% confidence interval: 0.69-0.91, = 0.001).
Sarcopenia is seen in about half of the patients with chronic advanced liver disease. It is commoner in males, patients with alcoholic liver disease, and those with advanced liver disease. Patients with sarcopenia have worse prognosis, require more frequent hospitalization and it negatively impacts short-term survival.
肌肉减少症在慢性晚期肝病中很常见，且与预后不良相关。关于慢性晚期肝病中肌肉减少症及其对预后影响的印度数据较少。本研究的目的是研究印度慢性晚期肝病患者中肌肉减少症的患病率及其对发病率和短期死亡率的影响。
对慢性晚期肝病患者进行前瞻性评估，使用腹部计算机断层扫描（CT）检测肌肉减少症的存在。在第三腰椎（L3）测量右腰大肌的横截面积，并计算腰大肌指数（PMI）。肌肉减少症的定义为女性PMI<295mm/m，男性PMI<356mm/m。PMI的标准值来自因非特异性腹痛接受CT扫描且无可能导致肌肉减少症的混杂因素的患者。所有患者随访6个月或直至死亡，以较早者为准。在6个月末评估肌肉减少症对死亡率和再入院率的影响。
156例慢性晚期肝病患者中，74例（47.4%）有肌肉减少症。肌肉减少症在男性（男：女=61:13）和酒精性肝病患者中更常见。根据Child-Pugh评分和终末期肝病模型（MELD）评分评估，PMI与肝病严重程度之间存在线性负相关（r分别为-0.591和-0.465）。有肝性脑病、腹水和凝血功能障碍的患者肌肉减少症患病率更高。在6个月的随访中，肌肉减少症患者的再入院率更高（74.3%对22%；P=0.0001），死亡率更高（24.3%对3.7%；P=0.002）。MELD评分和PMI是死亡率的独立预测因素。PMI的临界值为305.9mm/m时预测死亡率的敏感性为76.2%，假阳性率为22.2%（曲线下面积为0.805；95%置信区间：0.69-0.91，P=0.001）。
约一半的慢性晚期肝病患者存在肌肉减少症。在男性、酒精性肝病患者和晚期肝病患者中更常见。肌肉减少症患者预后较差，需要更频繁住院，且对短期生存有负面影响。
