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Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent.
Eur J Gastroenterol Hepatol 2013; 25(1):85-93EJ

Abstract

BACKGROUND

Sarcopenia is the most frequent complication of cirrhosis. A transjugular intrahepatic portosystemic stent (TIPS) lowers portal pressure in cirrhosis and alters the body composition. Changes in the skeletal muscle area and adipose tissue volume were quantified by computed tomography (CT) before and after TIPS.

MATERIALS AND METHODS

Fifty-seven consecutive cirrhotics who had a CT scan before and after TIPS were studied. Simultaneous age-matched, sex-matched, Child's score-matched, and Model for End-Stage Liver Disease score-matched cirrhotics (n=32) who did not undergo TIPS comprised the disease control and 57 healthy individuals who had undergone CT abdomen comprised the healthy control population. Muscle area and fat volume were obtained at the mid-L4 vertebra level on the CT scans.

RESULTS

Patients (mean age 55.5±8.1 years) were followed up for a mean of 13.5±11.9 months following TIPS. Total psoas and paraspinal muscle area increased significantly (P<0.0001) after TIPS (from 22.8±0.9 to 25.1±0.9 cm and 54.5±1.3 to 57.9±1.5 cm, respectively). After TIPS, muscle area increased in 41 patients but remained unchanged or decreased in 16 patients. Post-TIPS visceral fat volume decreased significantly (47.7±4.1 to 40.5±3.4 cm; P<0.001). Failure to reverse sarcopenia after TIPS was accompanied by higher (P=0.007) mortality (43.5%) compared with patients in whom the total muscle area increased (9.8%). On multivariate analysis, predictors of reversal of sarcopenia after TIPS included male sex and lower pre-TIPS muscle area. Cirrhotic patients who did not undergo TIPS showed no change in the mean muscle area over 13.1±1.3 months.

CONCLUSION

TIPS reverses sarcopenia in cirrhotic patients. Failure to improve muscle area after TIPS was accompanied by a higher mortality.

Authors+Show Affiliations

Departments of Gastroenterology, Hepatology and Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23011041

Citation

Tsien, Cynthia, et al. "Reversal of Sarcopenia Predicts Survival After a Transjugular Intrahepatic Portosystemic Stent." European Journal of Gastroenterology & Hepatology, vol. 25, no. 1, 2013, pp. 85-93.
Tsien C, Shah SN, McCullough AJ, et al. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastroenterol Hepatol. 2013;25(1):85-93.
Tsien, C., Shah, S. N., McCullough, A. J., & Dasarathy, S. (2013). Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. European Journal of Gastroenterology & Hepatology, 25(1), pp. 85-93. doi:10.1097/MEG.0b013e328359a759.
Tsien C, et al. Reversal of Sarcopenia Predicts Survival After a Transjugular Intrahepatic Portosystemic Stent. Eur J Gastroenterol Hepatol. 2013;25(1):85-93. PubMed PMID: 23011041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. AU - Tsien,Cynthia, AU - Shah,Shetal N, AU - McCullough,Arthur J, AU - Dasarathy,Srinivasan, PY - 2012/9/27/entrez PY - 2012/9/27/pubmed PY - 2013/5/15/medline SP - 85 EP - 93 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 25 IS - 1 N2 - BACKGROUND: Sarcopenia is the most frequent complication of cirrhosis. A transjugular intrahepatic portosystemic stent (TIPS) lowers portal pressure in cirrhosis and alters the body composition. Changes in the skeletal muscle area and adipose tissue volume were quantified by computed tomography (CT) before and after TIPS. MATERIALS AND METHODS: Fifty-seven consecutive cirrhotics who had a CT scan before and after TIPS were studied. Simultaneous age-matched, sex-matched, Child's score-matched, and Model for End-Stage Liver Disease score-matched cirrhotics (n=32) who did not undergo TIPS comprised the disease control and 57 healthy individuals who had undergone CT abdomen comprised the healthy control population. Muscle area and fat volume were obtained at the mid-L4 vertebra level on the CT scans. RESULTS: Patients (mean age 55.5±8.1 years) were followed up for a mean of 13.5±11.9 months following TIPS. Total psoas and paraspinal muscle area increased significantly (P<0.0001) after TIPS (from 22.8±0.9 to 25.1±0.9 cm and 54.5±1.3 to 57.9±1.5 cm, respectively). After TIPS, muscle area increased in 41 patients but remained unchanged or decreased in 16 patients. Post-TIPS visceral fat volume decreased significantly (47.7±4.1 to 40.5±3.4 cm; P<0.001). Failure to reverse sarcopenia after TIPS was accompanied by higher (P=0.007) mortality (43.5%) compared with patients in whom the total muscle area increased (9.8%). On multivariate analysis, predictors of reversal of sarcopenia after TIPS included male sex and lower pre-TIPS muscle area. Cirrhotic patients who did not undergo TIPS showed no change in the mean muscle area over 13.1±1.3 months. CONCLUSION: TIPS reverses sarcopenia in cirrhotic patients. Failure to improve muscle area after TIPS was accompanied by a higher mortality. SN - 1473-5687 UR - https://www.unboundmedicine.com/medline/citation/23011041/Reversal_of_sarcopenia_predicts_survival_after_a_transjugular_intrahepatic_portosystemic_stent_ L2 - http://Insights.ovid.com/pubmed?pmid=23011041 DB - PRIME DP - Unbound Medicine ER -