El Khoueiry Christele, Slim Rita, Rida Mohammad, Khoury Bernard, Honein Khalil, Smayra Tarek, Yaghi Cesar
Hotel Dieu de France Hospital, Beirut, Lebanon.
Middle East J Dig Dis. 2024 Apr;16(2):102-108. doi: 10.34172/mejdd.2024.376. Epub 2024 Apr 30.
Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis.
This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density.
The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE.
The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.
衰弱与肝硬化患者肝失代偿发生率及死亡率增加相关。我们研究的目的是确定一种新的影像学评分，以预测肝硬化患者的衰弱情况及其影响。
本研究纳入了51例肝硬化患者。我们使用衰弱量表风险评估评分来识别衰弱患者。在计算机断层扫描（CT）图像上分析L3水平不同肌肉的密度和面积。将根据身高和密度比调整后的L3骨骼肌面积（L3-SMDHR）定义为L3肌肉壁×身高/密度。
衰弱患者以及Child B/C评分患者的L3-SMHDR显著更高。衰弱与L3-SMHDR相关。衰弱和L3-SMHDR与肝脏相关事件（LRE）相关。我们通过使用ROC曲线为L3-SMHDR设定了灵敏度和特异性最合适的截断值：男性为5.4，女性为4.7。男性患者的AUROC评分为0.784，女性患者为0.975。衰弱与L3-SMHDR之间的Kappa评分为0.752，一致性百分比为87.5%，显示出高度一致性。该分类比例的灵敏度为100%，特异性为76%，阳性预测值为79.3%，阴性预测值为100%。L3-SMHDR高的患者生存时间显著缩短，LRE发生率更高。
L3-SMHDR是一种通过可测量和可重复的变量来识别肝硬化患者衰弱的新指标。它可作为肝硬化患者衰弱的预后因素。
