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Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis.
Clin Transl Gastroenterol. 2015 Jul 16; 6:e102.CT

Abstract

OBJECTIVES

Limitations of the Model for End-Stage Liver Disease (MELD) score include its failure to assess the nutritional and functional status of cirrhotic patients. Our objectives were to evaluate the impact of sarcopenia in cirrhosis and whether the inclusion of muscularity assessment within MELD could improve the prediction of mortality in patients with cirrhosis.

METHODS

We included 669 cirrhotic patients who were consecutively evaluated for liver transplantation. Skeletal muscle index at the third lumbar vertebra (L3 SMI) was measured by computed tomography, and sarcopenia was defined using previously published gender and body mass index-specific cutoffs. Using Cox proportional hazards regression, a novel MELD-sarcopenia score was derived.

RESULTS

Sarcopenia was present in 298 patients (45%); sarcopenic patients had shorter median survival than non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality. Overall, the c-statistics for 3-month mortality were 0.82 (95% CI 0.78-0.87) for MELD and 0.85 (95% CI 0.81-0.88) for MELD-sarcopenia (P=0.1). Corresponding figures for 1-year mortality were 0.73 (95% CI 0.69-0.77) and 0.77 (95% CI 0.73-0.80), respectively (P=0.03). The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.

CONCLUSIONS

Modification of MELD to include sarcopenia is associated with improved prediction of mortality in patients with cirrhosis, primarily in patients with low MELD scores. External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

Authors+Show Affiliations

Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.Division of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.1] Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.Department of Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada.1] Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26181291

Citation

Montano-Loza, Aldo J., et al. "Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis." Clinical and Translational Gastroenterology, vol. 6, 2015, pp. e102.
Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, et al. Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. Clin Transl Gastroenterol. 2015;6:e102.
Montano-Loza, A. J., Duarte-Rojo, A., Meza-Junco, J., Baracos, V. E., Sawyer, M. B., Pang, J. X., Beaumont, C., Esfandiari, N., & Myers, R. P. (2015). Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. Clinical and Translational Gastroenterology, 6, e102. https://doi.org/10.1038/ctg.2015.31
Montano-Loza AJ, et al. Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. Clin Transl Gastroenterol. 2015 Jul 16;6:e102. PubMed PMID: 26181291.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. AU - Montano-Loza,Aldo J, AU - Duarte-Rojo,Andres, AU - Meza-Junco,Judith, AU - Baracos,Vickie E, AU - Sawyer,Michael B, AU - Pang,Jack X Q, AU - Beaumont,Crystal, AU - Esfandiari,Nina, AU - Myers,Robert P, Y1 - 2015/07/16/ PY - 2014/11/24/received PY - 2015/05/11/accepted PY - 2015/7/17/entrez PY - 2015/7/17/pubmed PY - 2015/7/17/medline SP - e102 EP - e102 JF - Clinical and translational gastroenterology JO - Clin Transl Gastroenterol VL - 6 N2 - OBJECTIVES: Limitations of the Model for End-Stage Liver Disease (MELD) score include its failure to assess the nutritional and functional status of cirrhotic patients. Our objectives were to evaluate the impact of sarcopenia in cirrhosis and whether the inclusion of muscularity assessment within MELD could improve the prediction of mortality in patients with cirrhosis. METHODS: We included 669 cirrhotic patients who were consecutively evaluated for liver transplantation. Skeletal muscle index at the third lumbar vertebra (L3 SMI) was measured by computed tomography, and sarcopenia was defined using previously published gender and body mass index-specific cutoffs. Using Cox proportional hazards regression, a novel MELD-sarcopenia score was derived. RESULTS: Sarcopenia was present in 298 patients (45%); sarcopenic patients had shorter median survival than non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality. Overall, the c-statistics for 3-month mortality were 0.82 (95% CI 0.78-0.87) for MELD and 0.85 (95% CI 0.81-0.88) for MELD-sarcopenia (P=0.1). Corresponding figures for 1-year mortality were 0.73 (95% CI 0.69-0.77) and 0.77 (95% CI 0.73-0.80), respectively (P=0.03). The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD. CONCLUSIONS: Modification of MELD to include sarcopenia is associated with improved prediction of mortality in patients with cirrhosis, primarily in patients with low MELD scores. External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted. SN - 2155-384X UR - https://www.unboundmedicine.com/medline/citation/26181291/Inclusion_of_Sarcopenia_Within_MELD__MELD_Sarcopenia__and_the_Prediction_of_Mortality_in_Patients_With_Cirrhosis_ L2 - http://dx.doi.org/10.1038/ctg.2015.31 DB - PRIME DP - Unbound Medicine ER -
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