Zheng Jiarui, Yang Shuo, Ren Wenhui, Zhong Juan, Liu Xin, Han Rui, Wei Tingyang, Tie Changjie, Yang Yuteng, Hong Chengwu, Feng Bo, Huang Rui
Department of Hepatology, Peking University Hepatology Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
Department of Radiology, Peking University People' s Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
Heliyon. 2024 Aug 3;10(15):e35354. doi: 10.1016/j.heliyon.2024.e35354. eCollection 2024 Aug 15.
Sarcopenia has a detrimental impact on the prognosis of individuals with liver cirrhosis, however, the clinical significance of alterations in muscle mass remains uncertain. This study aims to investigate the influence of loss of skeletal muscle mass (LSMM) on the prognostic outcomes among patients diagnosed with cirrhosis.
In this retrospective analysis, a total of 158 individuals with cirrhosis who visited our hospital during the period from January 2018 to August 2023 were included. Computed tomography was utilized to measure the cross-sectional area of the skeletal muscles at the level of the third lumbar vertebra. This measurement enabled the determination of the skeletal muscle index for the purpose of diagnosing sarcopenia. The annual relative change in skeletal muscle area (ΔSMA/y) was calculated for each patient, and LSMM was defined as ΔSMA/y < 0. To assess the risk factors associated with liver-related mortality, a competing risk model was applied.
Of the 158 cirrhotic patients, 95 (60.1 %) patients were identified as LSMM. The median of ΔSMA/y% was -0.9 (interquartile range [IQR], -3.8, 1.6) in all patients. Chronic kidney disease (CKD) was confirmed as a risk factor of LSMM. During a median follow-up period of 68.1 (IQR, 43.5, 105.0) months, 57 patients (36.1 %) died due to the liver-related diseases. The competing risk model found that LSMM was significantly associated with liver-related mortality in cirrhotic patients (hazard ratio [HR], 1.86; 95 % CI, 1.01-3.44, = 0.047). Cumulative survival was significantly higher in patients without LSMM than in those with LSMM ( = 0.004). Survival rates at 1-, 3-, and 5-years were 96.8 %, 81.0 %, and 65.1 %, respectively, in patients without LSMM, and 97.9 %, 80.0 %, and 56.8 %, respectively, in patients with LSMM.
The utilization of LSMM can be valuable in the prediction of liver-related mortality among individuals diagnosed with liver cirrhosis. Paying attention to the management of skeletal muscle might play a role in enhancing the prognosis of patients with cirrhosis.
This study provides an additional indicator-LSMM for clinicians to help predict the liver-related mortality in patients diagnosed with cirrhosis.
肌肉减少症对肝硬化患者的预后有不利影响，然而，肌肉量改变的临床意义仍不明确。本研究旨在调查骨骼肌量减少（LSMM）对肝硬化诊断患者预后结果的影响。
在这项回顾性分析中，纳入了2018年1月至2023年8月期间到我院就诊的158例肝硬化患者。利用计算机断层扫描测量第三腰椎水平的骨骼肌横截面积。该测量用于确定骨骼肌指数以诊断肌肉减少症。计算每位患者的骨骼肌面积年度相对变化（ΔSMA/y），并将LSMM定义为ΔSMA/y < 0。为评估与肝脏相关死亡率相关的危险因素，应用了竞争风险模型。
在158例肝硬化患者中，95例（60.1%）患者被确定为LSMM。所有患者的ΔSMA/y%中位数为 -0.9（四分位间距[IQR]，-3.8，1.6）。慢性肾脏病（CKD）被确认为LSMM的一个危险因素。在中位随访期68.1（IQR，43.5，105.0）个月期间，57例患者（36.1%）死于肝脏相关疾病。竞争风险模型发现，LSMM与肝硬化患者的肝脏相关死亡率显著相关（风险比[HR]，1.86；95%置信区间，1.01 - 3.44，P = 0.047）。无LSMM患者的累积生存率显著高于有LSMM的患者（P = 0.004）。无LSMM患者1年、3年和5年的生存率分别为96.8%、81.0%和65.1%，有LSMM患者分别为97.9%、80.0%和56.8%。
LSMM的应用在预测肝硬化诊断患者的肝脏相关死亡率方面可能具有价值。关注骨骼肌的管理可能在改善肝硬化患者的预后中发挥作用。
本研究为临床医生提供了一个额外的指标——LSMM，以帮助预测肝硬化诊断患者的肝脏相关死亡率。
