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Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography.
J Hepatol 2014; 60(6):1151-7JH

Abstract

BACKGROUND & AIMS

Waiting-list mortality in patients with cirrhosis and a relatively low MELD score is a matter of concern. The aim of this study was to determine whether a marker of muscle waste could improve prognostication.

METHODS

A pre-MELD cohort (waiting time-based allocation; n=186) and a MELD-era cohort (n=376) were examined. At evaluation, transversal psoas muscle thickness (TPMT) was measured on a computed tomography (CT) image at the level of the umbilicus. In the pre-MELD cohort, TPMT/height (mm/m) and the MELD score were entered in univariate and multivariate models to predict mortality after registration. Applicability of pre-MELD findings was tested in the MELD-era.

RESULTS

In the pre-MELD cohort, the MELD score and TPMT/height were significantly associated with mortality. The discrimination of a score combining MELD and TPMT/height (MELD-psoas) was 0.84 (95% CI, 0.62-0.95). In the MELD-era, TPTM/height was significantly associated with mortality, independent of the MELD and MELD-Na scores. There was a 15% increase in mortality risk per unit decrease in TPMT/height. The discrimination of MELD-psoas score (0.82; 95% CI, 0.64-0.93) was superior to that of the MELD score and similar to that of the MELD-Na score. In patients with refractory ascites, mortality was significantly higher when TPMT/height was <16.8 mm/m (42% vs. 9%, p=0.02).

CONCLUSIONS

TPMP/height on CT at the level of the umbilicus, an objective marker of muscle waste, may be predictive of mortality in cirrhotic patients, independent of the MELD and MELD-Na scores. It may help to better assess the prognosis of patients with refractory ascites.

Authors+Show Affiliations

Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France. Electronic address: francois.durand@bjn.aphp.fr.Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France.Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.Biostatistics Department, Hospital Bichat, Paris, France; INSERM UMR 738, Université Paris Diderot, Sorbonne Paris Cité, France.Department of Radiology, Hospital Beaujon, Clichy, France.Hepatobiliary Surgery and Liver Transplantation, Hospital Beaujon, Clichy, France.Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France; Department of Radiology, Hospital Beaujon, Clichy, France.Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24607622

Citation

Durand, François, et al. "Prognostic Value of Muscle Atrophy in Cirrhosis Using Psoas Muscle Thickness On Computed Tomography." Journal of Hepatology, vol. 60, no. 6, 2014, pp. 1151-7.
Durand F, Buyse S, Francoz C, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. J Hepatol. 2014;60(6):1151-7.
Durand, F., Buyse, S., Francoz, C., Laouénan, C., Bruno, O., Belghiti, J., ... Valla, D. (2014). Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. Journal of Hepatology, 60(6), pp. 1151-7. doi:10.1016/j.jhep.2014.02.026.
Durand F, et al. Prognostic Value of Muscle Atrophy in Cirrhosis Using Psoas Muscle Thickness On Computed Tomography. J Hepatol. 2014;60(6):1151-7. PubMed PMID: 24607622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. AU - Durand,François, AU - Buyse,Sophie, AU - Francoz,Claire, AU - Laouénan,Cédric, AU - Bruno,Onorina, AU - Belghiti,Jacques, AU - Moreau,Richard, AU - Vilgrain,Valérie, AU - Valla,Dominique, Y1 - 2014/03/06/ PY - 2013/09/09/received PY - 2014/02/03/revised PY - 2014/02/22/accepted PY - 2014/3/11/entrez PY - 2014/3/13/pubmed PY - 2015/1/7/medline KW - Cirrhosis KW - Liver transplantation KW - MELD score KW - Refractory ascites KW - Sarcopenia SP - 1151 EP - 7 JF - Journal of hepatology JO - J. Hepatol. VL - 60 IS - 6 N2 - BACKGROUND & AIMS: Waiting-list mortality in patients with cirrhosis and a relatively low MELD score is a matter of concern. The aim of this study was to determine whether a marker of muscle waste could improve prognostication. METHODS: A pre-MELD cohort (waiting time-based allocation; n=186) and a MELD-era cohort (n=376) were examined. At evaluation, transversal psoas muscle thickness (TPMT) was measured on a computed tomography (CT) image at the level of the umbilicus. In the pre-MELD cohort, TPMT/height (mm/m) and the MELD score were entered in univariate and multivariate models to predict mortality after registration. Applicability of pre-MELD findings was tested in the MELD-era. RESULTS: In the pre-MELD cohort, the MELD score and TPMT/height were significantly associated with mortality. The discrimination of a score combining MELD and TPMT/height (MELD-psoas) was 0.84 (95% CI, 0.62-0.95). In the MELD-era, TPTM/height was significantly associated with mortality, independent of the MELD and MELD-Na scores. There was a 15% increase in mortality risk per unit decrease in TPMT/height. The discrimination of MELD-psoas score (0.82; 95% CI, 0.64-0.93) was superior to that of the MELD score and similar to that of the MELD-Na score. In patients with refractory ascites, mortality was significantly higher when TPMT/height was <16.8 mm/m (42% vs. 9%, p=0.02). CONCLUSIONS: TPMP/height on CT at the level of the umbilicus, an objective marker of muscle waste, may be predictive of mortality in cirrhotic patients, independent of the MELD and MELD-Na scores. It may help to better assess the prognosis of patients with refractory ascites. SN - 1600-0641 UR - https://www.unboundmedicine.com/medline/citation/24607622/Prognostic_value_of_muscle_atrophy_in_cirrhosis_using_psoas_muscle_thickness_on_computed_tomography_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8278(14)00134-2 DB - PRIME DP - Unbound Medicine ER -