Dajti Elton, Rodrigues Susana G, Perazza Federica, Colecchia Luigi, Marasco Giovanni, Renzulli Matteo, Barbara Giovanni, Azzaroli Francesco, Berzigotti Annalisa, Colecchia Antonio, Ravaioli Federico
Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
JHEP Rep. 2024 May 6;6(8):101113. doi: 10.1016/j.jhepr.2024.101113. eCollection 2024 Aug.
BACKGROUND & AIMS: Sarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia.
Medline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95% CIs were pooled using a random-effects model.
Thirty-nine studies comprising 12,827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95% CI 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95% CI 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95% CI 1.53-2.26) (n = 14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk of publication bias.
Sarcopenia on CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice.
Sarcopenia assessed by the reference standard (computed tomography scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplant candidates. Stratifying for the parameters and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at present.
肌肉减少症与肝硬化患者的发病率和死亡率增加相关，但目前文献中其定义非常不一致。我们进行了一项系统评价和荟萃分析，以评估肝硬化患者中通过计算机断层扫描（CT）评估的肌肉减少症与死亡率之间的关联，包括总体情况以及根据用于定义肌肉减少症的标准进行分层分析。
检索截至2023年1月的Medline、Embase、Scopus和Cochrane图书馆。我们纳入了通过CT扫描评估肌肉减少症存在情况并提供死亡率风险数据的研究。使用随机效应模型汇总调整后的风险比（HR）和95%置信区间（CI）。
荟萃分析纳入了39项研究，共12,827例患者。肌肉减少症的总体患病率为44%（95%CI 38 - 50%）。肌肉减少症（任何定义）的存在是死亡率的独立预测因素，调整后的HR为2.07（95%CI 1.81 - 2.36），并且在所有亚组分析中结果一致。首次证实了欧洲肝脏研究学会/美国肝病研究学会（EASL/AASLD）标准的预后作用，HR为1.86（95%CI 1.53 - 2.26）（n = 14项研究）。基于腰大肌参数定义肌肉减少症的截断值在不同研究中有所不同，因此，亚组分析不可行。主要估计值没有实质性异质性，也没有显著的发表偏倚风险。
CT检查发现的肌肉减少症与肝硬化患者死亡率高出2倍的风险相关。EASL/AASLD提出的截断值具有预后相关性，应成为临床实践中用于定义肌肉减少症的推荐标准。
通过参考标准（计算机断层扫描）评估的肌肉减少症是肝硬化患者死亡率的独立预测因素，在所有敏感性分析中死亡风险增加2倍。这一发现尤其适用于来自欧洲和北美的患者以及移植候选者。根据所使用的参数和截断值进行分层，我们首次证实了EASL/AASLD提出的定义的预后影响，支持其在临床实践中的应用。腰大肌评估很有前景，但目前数据仍然有限且过于不一致，无法推荐常规使用。
