Johnston Heidi E, Mayr Hannah L, Andelkovic Melita, Takefala Tahnie G, Chen Yanyan, Thrift Aaron P, Macdonald Graeme A, Hickman Ingrid J
Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia.
Hepatol Commun. 2025 May 29;9(6). doi: 10.1097/HC9.0000000000000701. eCollection 2025 Jun 1.
Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes.
The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia and receiving an LT, unplanned admissions pre-LT, surgical complications, and length of stay for the LT admission. Fine-Gray competing risk analysis explored the impact of sarcopenia on receiving an LT and unplanned admissions. The AUC determined the predictive utility of the criteria.
The prevalence of CT-defined sarcopenia (52%) was more than twice and 4-fold that of EWGSOP1-defined (22%) and EWGSOP2-defined (11%) sarcopenia, respectively. No criteria demonstrated a significant association with time to LT nor the time to unplanned admissions pre-LT. Similarly, none of the 3 criteria had superior predictive utility for the clinical outcomes for unplanned hospital admissions pre-LT of receiving an LT, with all 3 criteria having identical moderate AUCs for unplanned admissions (0.70) and similar weak AUCs (≤0.55) for the likelihood of receiving an LT.
Sarcopenia in patients undergoing LT evaluation is prevalent. EWGSOP criteria appear to offer no advantage over CT-only criteria in identifying patients at increased risk of adverse LT outcomes. Bedside measures of muscle function may be of benefit in tracking the effectiveness of interventions targeting sarcopenia.
肌肉减少症是一种严重的肌肉萎缩综合征，与肝移植（LT）相关的不良后果有关。有几种方法可用于识别肌肉减少症。我们旨在使用3种不同的标准调查肌肉减少症的患病率，并确定这些标准在临床结局方面的表现。
队列研究纳入了237名因LT而转诊的肝硬化成人患者。使用（1）CT定义；以及（2）原始和（3）更新后的欧洲老年人肌肉减少症工作组标准（EWGSOP1和EWGSOP2）来识别肌肉减少症。采用逻辑回归估计肌肉减少症与接受LT、LT前计划外入院、手术并发症以及LT住院时间之间关系的OR和95%CI。精细灰色竞争风险分析探讨了肌肉减少症对接受LT和计划外入院的影响。AUC确定了这些标准的预测效用。
CT定义的肌肉减少症患病率（52%）分别是EWGSOP1定义的（22%）和EWGSOP定义的（11%）肌肉减少症患病率的两倍多和四倍。没有标准显示与LT时间或LT前计划外入院时间有显著关联。同样，这3种标准中没有一种对LT前计划外入院的临床结局具有更好的预测效用，所有3种标准对计划外入院的AUC均为中等（0.70），对接受LT可能性的AUC均较弱（≤0.55）。
接受LT评估的患者中肌肉减少症很普遍。在识别LT不良结局风险增加的患者方面，EWGSOP标准似乎并不比仅使用CT的标准更具优势。床边肌肉功能测量可能有助于跟踪针对肌肉减少症的干预措施的效果。
