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Muscle wasting is associated with mortality in patients with cirrhosis.
Clin Gastroenterol Hepatol 2012; 10(2):166-73, 173.e1CG

Abstract

BACKGROUND & AIMS

Sarcopenia, defined as a low level of muscle mass, occurs in patients with cirrhosis. We assessed its incidence among cirrhotic patients undergoing evaluation for liver transplantation to investigate associations between sarcopenia and mortality and prognosis.

METHODS

We studied 112 patients with cirrhosis (78 men; mean age, 54 ± 1 years) who were consecutively evaluated for liver transplantation and had a computed tomography scan at the level of the third lumbar (L3) vertebrae to determine the L3 skeletal muscle index; sarcopenia was defined by using previously published, sex-specific cutoffs.

RESULTS

Of the patients studied, 45 (40%) had sarcopenia. Univariate Cox analysis associated mortality with ascites (hazard ratio [HR], 2.12; P = .04), encephalopathy (HR, 1.99; P = .04), level of bilirubin (HR, 1.007; P < .01), international normalized ratio (HR, 7.69; P < .001), level of creatinine (HR, 1.01; P = .005), level of albumin (HR, 94; P = .008), serum level of sodium (HR, 89; P < .001), Model for End-Stage Liver Disease (MELD) score (HR, 1.14; P < .01), Child-Pugh score (HR, 2.84; P < .001), and sarcopenia (HR, 2.18; P = .006). By multivariate Cox analysis, only Child-Pugh (HR, 1.85; P = .04) and MELD scores (HR, 1.08; P = .001) and sarcopenia (HR, 2.21; P = .008) were independently associated with mortality. The median survival time for patients with sarcopenia was 19 ± 6 months, compared with 34 ± 11 months among nonsarcopenia patients (P = .005). There was a low level of correlation between L3 skeletal muscle index and MELD (r = -0.07; P = .5) and Child-Pugh scores (r = -0.14; P = .1).

CONCLUSIONS

Sarcopenia is associated with mortality in patients with cirrhosis. It does not correlate with the degree of liver dysfunction evaluated by using conventional scoring systems. Scoring systems should include evaluation of sarcopenia to better assess mortality among patients with cirrhosis.

Authors+Show Affiliations

Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada. aldo.montano-loza@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21893129

Citation

Montano-Loza, Aldo J., et al. "Muscle Wasting Is Associated With Mortality in Patients With Cirrhosis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 10, no. 2, 2012, pp. 166-73, 173.e1.
Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-73, 173.e1.
Montano-Loza, A. J., Meza-Junco, J., Prado, C. M., Lieffers, J. R., Baracos, V. E., Bain, V. G., & Sawyer, M. B. (2012). Muscle wasting is associated with mortality in patients with cirrhosis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 10(2), pp. 166-73, 173.e1. doi:10.1016/j.cgh.2011.08.028.
Montano-Loza AJ, et al. Muscle Wasting Is Associated With Mortality in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-73, 173.e1. PubMed PMID: 21893129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Muscle wasting is associated with mortality in patients with cirrhosis. AU - Montano-Loza,Aldo J, AU - Meza-Junco,Judith, AU - Prado,Carla M M, AU - Lieffers,Jessica R, AU - Baracos,Vickie E, AU - Bain,Vincent G, AU - Sawyer,Michael B, Y1 - 2011/09/03/ PY - 2011/04/18/received PY - 2011/08/16/revised PY - 2011/08/27/accepted PY - 2011/9/7/entrez PY - 2011/9/7/pubmed PY - 2012/5/12/medline SP - 166-73, 173.e1 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 10 IS - 2 N2 - BACKGROUND & AIMS: Sarcopenia, defined as a low level of muscle mass, occurs in patients with cirrhosis. We assessed its incidence among cirrhotic patients undergoing evaluation for liver transplantation to investigate associations between sarcopenia and mortality and prognosis. METHODS: We studied 112 patients with cirrhosis (78 men; mean age, 54 ± 1 years) who were consecutively evaluated for liver transplantation and had a computed tomography scan at the level of the third lumbar (L3) vertebrae to determine the L3 skeletal muscle index; sarcopenia was defined by using previously published, sex-specific cutoffs. RESULTS: Of the patients studied, 45 (40%) had sarcopenia. Univariate Cox analysis associated mortality with ascites (hazard ratio [HR], 2.12; P = .04), encephalopathy (HR, 1.99; P = .04), level of bilirubin (HR, 1.007; P < .01), international normalized ratio (HR, 7.69; P < .001), level of creatinine (HR, 1.01; P = .005), level of albumin (HR, 94; P = .008), serum level of sodium (HR, 89; P < .001), Model for End-Stage Liver Disease (MELD) score (HR, 1.14; P < .01), Child-Pugh score (HR, 2.84; P < .001), and sarcopenia (HR, 2.18; P = .006). By multivariate Cox analysis, only Child-Pugh (HR, 1.85; P = .04) and MELD scores (HR, 1.08; P = .001) and sarcopenia (HR, 2.21; P = .008) were independently associated with mortality. The median survival time for patients with sarcopenia was 19 ± 6 months, compared with 34 ± 11 months among nonsarcopenia patients (P = .005). There was a low level of correlation between L3 skeletal muscle index and MELD (r = -0.07; P = .5) and Child-Pugh scores (r = -0.14; P = .1). CONCLUSIONS: Sarcopenia is associated with mortality in patients with cirrhosis. It does not correlate with the degree of liver dysfunction evaluated by using conventional scoring systems. Scoring systems should include evaluation of sarcopenia to better assess mortality among patients with cirrhosis. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/21893129/Muscle_wasting_is_associated_with_mortality_in_patients_with_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(11)00916-5 DB - PRIME DP - Unbound Medicine ER -