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A Model to Identify Sarcopenia in Patients With Cirrhosis.
Clin Gastroenterol Hepatol 2016; 14(10):1473-1480.e3CG

Abstract

BACKGROUND & AIMS

The severe depletion of muscle mass at the third lumbar vertebral level (sarcopenia) is a marker of malnutrition and is independently associated with mortality in patients with cirrhosis. Instead of monitoring sarcopenia by cross-sectional imaging, we investigated whether ultrasound-based measurements of peripheral muscle mass, measures of muscle function, along with nutritional factors, are associated with severe loss of muscle mass.

METHODS

We performed a prospective study of 159 outpatients with cirrhosis (56% male; mean age, 58 ± 10 years; mean model for end-stage liver disease score, 10 ± 3; 60% Child-Pugh class A) evaluated at the Cirrhosis Care Clinic at the University of Alberta Hospital from March 2011 through September 2012. Lumbar skeletal muscle indices were determined by computed tomography or magnetic resonance imaging. We collected clinical data and data on patients' body composition, nutrition, and thigh muscle thickness (using ultrasound analysis). We also measured mid-arm muscle circumference, mid-arm circumference, hand grip, body mass index, and serum level of albumin; patients were evaluated using the subjective global assessment scale. Findings from these analyses were compared with those from cross-sectional imaging, for each sex, using logistic regression analysis.

RESULTS

Based on cross-sectional imaging analysis, 43% of patients had sarcopenia (57% of men and 25% of women). Results from the subjective global assessment, serum level of albumin, and most nutritional factors were significantly associated with sarcopenia. We used multivariate analysis to develop a model to identify patients with sarcopenia, and developed a nomogram based on body mass index and thigh muscle thickness for patients of each sex. Our model identified men with sarcopenia with an area under the receiver operating characteristic curve value of 0.78 and women with sarcopenia with an area under the receiver operating characteristic curve value of 0.89.

CONCLUSIONS

In a prospective study of patients with cirrhosis, we found that the combination of body mass index and thigh muscle thickness (measured by ultrasound) can identify male and female patients with sarcopenia almost as well as cross-sectional imaging (area under the receiver operating characteristic curve values of 0.78 and 0.89, respectively). These factors might be used in screening and routine nutritional monitoring of patients with cirrhosis.

Authors+Show Affiliations

Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: ptandon@ualberta.ca.Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Department of Medicine, University of Calgary, Calgary, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Department of Medicine, University of Calgary, Calgary, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27189915

Citation

Tandon, Puneeta, et al. "A Model to Identify Sarcopenia in Patients With Cirrhosis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 14, no. 10, 2016, pp. 1473-1480.e3.
Tandon P, Low G, Mourtzakis M, et al. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016;14(10):1473-1480.e3.
Tandon, P., Low, G., Mourtzakis, M., Zenith, L., Myers, R. P., Abraldes, J. G., ... Ma, M. (2016). A Model to Identify Sarcopenia in Patients With Cirrhosis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 14(10), pp. 1473-1480.e3. doi:10.1016/j.cgh.2016.04.040.
Tandon P, et al. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016;14(10):1473-1480.e3. PubMed PMID: 27189915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Model to Identify Sarcopenia in Patients With Cirrhosis. AU - Tandon,Puneeta, AU - Low,Gavin, AU - Mourtzakis,Marina, AU - Zenith,Laura, AU - Myers,Robert P, AU - Abraldes,Juan G, AU - Shaheen,Abdel Aziz M, AU - Qamar,Hina, AU - Mansoor,Nadia, AU - Carbonneau,Michelle, AU - Ismond,Kathleen, AU - Mann,Sumeer, AU - Alaboudy,Alshimaa, AU - Ma,Mang, Y1 - 2016/05/14/ PY - 2015/12/13/received PY - 2016/04/25/revised PY - 2016/04/28/accepted PY - 2016/5/19/entrez PY - 2016/5/18/pubmed PY - 2017/8/8/medline KW - CT KW - Diagnosis KW - Muscle Wasting KW - SGA SP - 1473 EP - 1480.e3 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 14 IS - 10 N2 - BACKGROUND & AIMS: The severe depletion of muscle mass at the third lumbar vertebral level (sarcopenia) is a marker of malnutrition and is independently associated with mortality in patients with cirrhosis. Instead of monitoring sarcopenia by cross-sectional imaging, we investigated whether ultrasound-based measurements of peripheral muscle mass, measures of muscle function, along with nutritional factors, are associated with severe loss of muscle mass. METHODS: We performed a prospective study of 159 outpatients with cirrhosis (56% male; mean age, 58 ± 10 years; mean model for end-stage liver disease score, 10 ± 3; 60% Child-Pugh class A) evaluated at the Cirrhosis Care Clinic at the University of Alberta Hospital from March 2011 through September 2012. Lumbar skeletal muscle indices were determined by computed tomography or magnetic resonance imaging. We collected clinical data and data on patients' body composition, nutrition, and thigh muscle thickness (using ultrasound analysis). We also measured mid-arm muscle circumference, mid-arm circumference, hand grip, body mass index, and serum level of albumin; patients were evaluated using the subjective global assessment scale. Findings from these analyses were compared with those from cross-sectional imaging, for each sex, using logistic regression analysis. RESULTS: Based on cross-sectional imaging analysis, 43% of patients had sarcopenia (57% of men and 25% of women). Results from the subjective global assessment, serum level of albumin, and most nutritional factors were significantly associated with sarcopenia. We used multivariate analysis to develop a model to identify patients with sarcopenia, and developed a nomogram based on body mass index and thigh muscle thickness for patients of each sex. Our model identified men with sarcopenia with an area under the receiver operating characteristic curve value of 0.78 and women with sarcopenia with an area under the receiver operating characteristic curve value of 0.89. CONCLUSIONS: In a prospective study of patients with cirrhosis, we found that the combination of body mass index and thigh muscle thickness (measured by ultrasound) can identify male and female patients with sarcopenia almost as well as cross-sectional imaging (area under the receiver operating characteristic curve values of 0.78 and 0.89, respectively). These factors might be used in screening and routine nutritional monitoring of patients with cirrhosis. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/27189915/A_Model_to_Identify_Sarcopenia_in_Patients_With_Cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(16)30198-7 DB - PRIME DP - Unbound Medicine ER -