Department of Clinical Epidemiology, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing 100044, China.
Peking University Hepatology Institute, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
Eur J Radiol. 2024 Nov;180:111707. doi: 10.1016/j.ejrad.2024.111707. Epub 2024 Aug 26.
Emerging evidence on cirrhosis suggests a close correlation between abnormality in body composition characteristics and poor prognosis. This study aimed to evaluate the impact of dynamic changes in body composition on the prognostic outcomes in patients with cirrhosis.
This retrospective analysis included 158 patients diagnosed as cirrhosis from January 2018 to August 2023. Skeletal muscle mass, muscle quality, visceral and subcutaneous adiposity were evaluated using computed tomography (CT) imaging at the third lumbar vertebra level. Competing risk model was performed four different body composition status (i.e., normal, only sarcopenia, only myosteatosis, and combined status) for liver-related mortality. We also explored the relationship between the dynamic change in body composition and long-term prognosis by applying Gray's test.
Of the 158 cirrhotic patients (mean [SD] age, 57.1 [12.6] years), sarcopenia was present in 85 (60.1 %) patients, while 22 (13.9 %) patients had sarcopenic obesity and 68 (43.0 %) had myosteatosis. Patients solely diagnosed with sarcopenia exhibited a higher mortality rate compared to those with normal body composition (Gray's test, P=0.006), while patients solely diagnosed with myosteatosis or with a combination of sarcopenia and myosteatosis did not reach statistical significance (Gray's test, P=0.076; P=0.140). Multivariable analysis also revealed that VSR (HR=1.10 [1.01∼1.20]; P=0.028), sarcopenia (HR=2.73 [1.20∼6.22], P=0.017) and myosteatosis (HR=2.39 [1.10∼5.18], P=0.028) were significant independent predictors of liver-related deaths. Otherwise, patients exhibiting aggravating body composition during follow-up period were associated with a significantly higher mortality risk compared to those with normal or remission body composition status (HR=7.63 [1.12∼51.14]; P=0.036).
Progressive alterations in body composition status appears to be associated with liver-related mortality in individuals with liver cirrhosis. Focusing on the management of skeletal muscle, along with visceral and subcutaneous adiposity, may contribute to improving the prognosis of cirrhotic patients.
越来越多的证据表明肝硬化患者的身体成分特征异常与预后不良密切相关。本研究旨在评估身体成分的动态变化对肝硬化患者预后的影响。
本回顾性分析纳入了 2018 年 1 月至 2023 年 8 月期间被诊断为肝硬化的 158 例患者。采用 CT 扫描第 3 腰椎水平评估骨骼肌量、肌肉质量、内脏和皮下脂肪。采用竞争风险模型分析 4 种不同的身体成分状态（即正常、单纯性肌肉减少症、单纯性肌脂病和联合状态）与肝相关死亡率的关系。我们还通过应用 Gray 检验探讨了身体成分动态变化与长期预后的关系。
在 158 例肝硬化患者中（平均[标准差]年龄，57.1[12.6]岁），85 例（60.1%）患者存在肌肉减少症，22 例（13.9%）患者存在肌脂病，68 例（43.0%）患者存在肌脂减少症。与正常身体成分的患者相比，仅诊断为肌肉减少症的患者死亡率更高（Gray 检验，P=0.006），而仅诊断为肌脂减少症或同时存在肌肉减少症和肌脂减少症的患者差异无统计学意义（Gray 检验，P=0.076；P=0.140）。多变量分析还显示，VSR（HR=1.10[1.01∼1.20]；P=0.028）、肌肉减少症（HR=2.73[1.20∼6.22]，P=0.017）和肌脂减少症（HR=2.39[1.10∼5.18]，P=0.028）是肝相关死亡的独立显著预测因子。此外，与正常或缓解身体成分状态的患者相比，随访期间身体成分恶化的患者死亡率显著更高（HR=7.63[1.12∼51.14]；P=0.036）。
肝硬化患者的身体成分状态的进行性改变似乎与肝相关死亡率有关。关注骨骼肌以及内脏和皮下脂肪的管理可能有助于改善肝硬化患者的预后。
