Zeng Fan, Jiang Wei, Chang Xiujun, Yang Fuxun, Luo Xiaoxiu, Liu Rongan, Lei Yu, Li Jiajia, Pan Chun, Huang Xiaobo, Sun Huaiqiang, Lan Yunping
Department of Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
Clinical Medicine School of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
J Cachexia Sarcopenia Muscle. 2024 Aug;15(4):1473-1482. doi: 10.1002/jcsm.13501. Epub 2024 Jul 5.
While sarcopenia is recognized as a predictor of mortality in cirrhosis, its influence on acute-on-chronic liver failure (ACLF) remains uncertain. Despite multiple studies examining the impact of sarcopenia on short-term mortality in patients with ACLF, the sample size of these studies was limited, and their outcomes were inconsistent. Therefore, this study aimed to explore the impact of sarcopenia on both short- and long-term mortality in patients with ACLF.
This retrospective cohort study included 414 patients with ACLF that were treated between January 2016 and September 2022. Sarcopenia was diagnosed based on the measurement of the skeletal muscle index at the third lumbar vertebra (L3-SMI). Subsequently, the patients were divided into sarcopenia and non-sarcopenia groups. We analysed the basic clinical data of the two groups. Multivariate Cox proportional analysis was used to analyse short-term (28 days) and long-term (1 year and overall) mortality rates.
A total of 414 patients were included, with a mean age of 52.88 ± 13.41 years. Among them, 318 (76.8%) were male, and 239 (57.7%) had sarcopenia. A total of 280 (67.6%) patients died during the study period. Among them, 153 patients died within 28 days (37%) and 209 patients died within 1 year (50.5%). We found that the 28-day, 1-year and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (37% vs. 22.3%, P < 0.01; 50.5% vs. 34.9%, P < 0.01; and 67.6% vs. 53.1%, P < 0.01, respectively). Multivariate Cox regression analysis revealed that sarcopenia was significantly associated with increased mortality. The hazard ratios for sarcopenia were 2.05 (95% confidence interval [CI] 1.41-3.00, P < 0.01) for 28-day mortality, 1.81 (95% CI 1.29-2.54, P < 0.01) for 1-year mortality and 1.82 (95% CI 1.30-2.55, P < 0.01) for overall mortality. In addition, muscle density and international normalized ratio were associated with short- and long-term mortality.
Sarcopenia is associated with both short- and long-term mortality in patients with ACLF. Therefore, regular monitoring for sarcopenia is important for these patients.
虽然肌肉减少症被认为是肝硬化患者死亡率的一个预测指标，但其对慢加急性肝衰竭（ACLF）的影响仍不确定。尽管有多项研究探讨了肌肉减少症对ACLF患者短期死亡率的影响，但这些研究的样本量有限，且结果不一致。因此，本研究旨在探讨肌肉减少症对ACLF患者短期和长期死亡率的影响。
这项回顾性队列研究纳入了2016年1月至2022年9月期间接受治疗的414例ACLF患者。根据第三腰椎（L3-SMI）处的骨骼肌指数测量结果诊断肌肉减少症。随后，将患者分为肌肉减少症组和非肌肉减少症组。我们分析了两组的基本临床数据。采用多因素Cox比例分析来分析短期（28天）和长期（1年及总体）死亡率。
共纳入414例患者，平均年龄为52.88±13.41岁。其中，318例（76.8%）为男性，239例（57.7%）患有肌肉减少症。共有280例（67.6%）患者在研究期间死亡。其中，153例患者在28天内死亡（37%），209例患者在1年内死亡（50.5%）。我们发现，肌肉减少症组的28天、1年和总体死亡率均显著高于非肌肉减少症组（分别为37%对22.3%，P<0.01；50.5%对34.9%，P<0.01；67.6%对53.1%，P<0.01）。多因素Cox回归分析显示，肌肉减少症与死亡率增加显著相关。肌肉减少症的28天死亡率风险比为2.05（95%置信区间[CI]1.41-3.00，P<0.01），1年死亡率风险比为1.81（95%CI 1.29-2.54，P<0.01），总体死亡率风险比为1.82（95%CI 1.30-2.55，P<0.01）。此外，肌肉密度和国际标准化比值与短期和长期死亡率相关。
肌肉减少症与ACLF患者的短期和长期死亡率均相关。因此，对这些患者定期监测肌肉减少症很重要。
