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A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation.
Liver Transpl 2017; 23(2):143-154LT

Abstract

Although sarcopenia is a common complication of cirrhosis, its diagnosis remains nonconsensual: computed tomography (CT) scan determinations vary and no cutoff values have been established in cirrhotic populations undergoing liver transplantation (LT). Our aim was to compare the accuracy of the most widely used measurement techniques and to establish useful cutoffs in the setting of LT. From the 440 patients transplanted between January 2008 and May 2011 in our tertiary center, we selected 256 patients with cirrhosis for whom a recent CT scan was available during the 4 months prior to LT. We measured different muscle indexes: psoas muscle area (PMA), PMA normalized by height or body surface area (BSA), and the third lumbar vertebra skeletal muscle index (L3SMI). Receiver operating characteristic curves were evaluated and prognostic factors for post-LT 1-year survival were then analyzed. PMA offered better accuracy (area under the curve [AUC] = 0.753) than L3SMI (AUC = 0.707) and PMA/BSA (AUC = 0.732), and the same accuracy as PMA/squared height. So, for its accuracy and simplicity of use, the PMA index was used for the remainder of the analysis and to define sarcopenia. In men, the better cutoff value for PMA was 1561 mm2 (Se = 94%, Sp = 57%), whereas in women, it was 1464 mm2 (Se = 52%, Sp = 91%). A PMA lower than these values defined sarcopenia in patients with cirrhosis awaiting LT. One- and 5-year overall survival rates were significantly poorer in the sarcopenic group (n = 57) than in the nonsarcopenic group (n = 199), at 59% versus 94% and 54% versus 80%, respectively (P < 0.001). In conclusion, pre-LT PMA is a simple tool to assess sarcopenia. We established sex-specific cutoff values (1561 mm2 in men, 1464 mm2 in women) in a cirrhotic population and showed that 1-year survival was significantly poorer in sarcopenic patients. Liver Transplantation 23 143-154 2017 AASLD.

Authors+Show Affiliations

AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 1193.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 776, INSERM, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 1193.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 1193.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 1193.AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France. Université Paris-Sud, Villejuif, France. Unit 1193.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28061014

Citation

Golse, Nicolas, et al. "A New Definition of Sarcopenia in Patients With Cirrhosis Undergoing Liver Transplantation." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 23, no. 2, 2017, pp. 143-154.
Golse N, Bucur PO, Ciacio O, et al. A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. Liver Transpl. 2017;23(2):143-154.
Golse, N., Bucur, P. O., Ciacio, O., Pittau, G., Sa Cunha, A., Adam, R., ... Vibert, E. (2017). A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 23(2), pp. 143-154. doi:10.1002/lt.24671.
Golse N, et al. A New Definition of Sarcopenia in Patients With Cirrhosis Undergoing Liver Transplantation. Liver Transpl. 2017;23(2):143-154. PubMed PMID: 28061014.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. AU - Golse,Nicolas, AU - Bucur,Petru Octav, AU - Ciacio,Oriana, AU - Pittau,Gabriella, AU - Sa Cunha,Antonio, AU - Adam,René, AU - Castaing,Denis, AU - Antonini,Teresa, AU - Coilly,Audrey, AU - Samuel,Didier, AU - Cherqui,Daniel, AU - Vibert,Eric, Y1 - 2017/01/06/ PY - 2016/07/25/received PY - 2016/09/13/revised PY - 2016/10/18/accepted PY - 2017/1/7/pubmed PY - 2017/11/3/medline PY - 2017/1/7/entrez SP - 143 EP - 154 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl. VL - 23 IS - 2 N2 - Although sarcopenia is a common complication of cirrhosis, its diagnosis remains nonconsensual: computed tomography (CT) scan determinations vary and no cutoff values have been established in cirrhotic populations undergoing liver transplantation (LT). Our aim was to compare the accuracy of the most widely used measurement techniques and to establish useful cutoffs in the setting of LT. From the 440 patients transplanted between January 2008 and May 2011 in our tertiary center, we selected 256 patients with cirrhosis for whom a recent CT scan was available during the 4 months prior to LT. We measured different muscle indexes: psoas muscle area (PMA), PMA normalized by height or body surface area (BSA), and the third lumbar vertebra skeletal muscle index (L3SMI). Receiver operating characteristic curves were evaluated and prognostic factors for post-LT 1-year survival were then analyzed. PMA offered better accuracy (area under the curve [AUC] = 0.753) than L3SMI (AUC = 0.707) and PMA/BSA (AUC = 0.732), and the same accuracy as PMA/squared height. So, for its accuracy and simplicity of use, the PMA index was used for the remainder of the analysis and to define sarcopenia. In men, the better cutoff value for PMA was 1561 mm2 (Se = 94%, Sp = 57%), whereas in women, it was 1464 mm2 (Se = 52%, Sp = 91%). A PMA lower than these values defined sarcopenia in patients with cirrhosis awaiting LT. One- and 5-year overall survival rates were significantly poorer in the sarcopenic group (n = 57) than in the nonsarcopenic group (n = 199), at 59% versus 94% and 54% versus 80%, respectively (P < 0.001). In conclusion, pre-LT PMA is a simple tool to assess sarcopenia. We established sex-specific cutoff values (1561 mm2 in men, 1464 mm2 in women) in a cirrhotic population and showed that 1-year survival was significantly poorer in sarcopenic patients. Liver Transplantation 23 143-154 2017 AASLD. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/28061014/A_new_definition_of_sarcopenia_in_patients_with_cirrhosis_undergoing_liver_transplantation_ L2 - https://doi.org/10.1002/lt.24671 DB - PRIME DP - Unbound Medicine ER -