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Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score.

Abstract

Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research.

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    ,

    Hee Yeon Kim, Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.

    Hee Yeon Kim, Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea.

    Source

    World journal of gastroenterology 21:25 2015 Jul 07 pg 7637-47

    MeSH

    Decision Support Techniques
    Disease Progression
    Health Status Indicators
    Humans
    Liver Cirrhosis
    Muscle, Skeletal
    Nutrition Assessment
    Nutritional Status
    Predictive Value of Tests
    Prevalence
    Risk Assessment
    Risk Factors
    Sarcopenia

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    26167066

    Citation

    Kim, Hee Yeon, and Jeong Won Jang. "Sarcopenia in the Prognosis of Cirrhosis: Going Beyond the MELD Score." World Journal of Gastroenterology, vol. 21, no. 25, 2015, pp. 7637-47.
    Kim HY, Jang JW. Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. World J Gastroenterol. 2015;21(25):7637-47.
    Kim, H. Y., & Jang, J. W. (2015). Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. World Journal of Gastroenterology, 21(25), pp. 7637-47. doi:10.3748/wjg.v21.i25.7637.
    Kim HY, Jang JW. Sarcopenia in the Prognosis of Cirrhosis: Going Beyond the MELD Score. World J Gastroenterol. 2015 Jul 7;21(25):7637-47. PubMed PMID: 26167066.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. AU - Kim,Hee Yeon, AU - Jang,Jeong Won, PY - 2015/01/26/received PY - 2015/03/20/revised PY - 2015/05/07/accepted PY - 2015/7/14/entrez PY - 2015/7/15/pubmed PY - 2016/3/16/medline KW - Liver cirrhosis KW - Model for end-stage liver diseases score KW - Mortality KW - Prognosis KW - Sarcopenia SP - 7637 EP - 47 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 21 IS - 25 N2 - Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/26167066/Sarcopenia_in_the_prognosis_of_cirrhosis:_Going_beyond_the_MELD_score_ L2 - http://www.wjgnet.com/1007-9327/full/v21/i25/7637.htm DB - PRIME DP - Unbound Medicine ER -