Tags

Type your tag names separated by a space and hit enter

Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis.
Hepatology 2018; 67(3):1014-1026Hep

Abstract

Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cutoff values are missing, and most studies have used computed tomography. This study evaluated fat-free muscle area (FFMA) as a marker of sarcopenia using magnetic resonance imaging (MRI) in patients with decompensated cirrhosis with transjugular intrahepatic portosystemic shunt (TIPS). The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the FFMA in 116 patients with cirrhosis by TIPS and MRI. The training cohort of 71 patients compared computed tomography-measured transversal psoas muscle thickness with FFMA. In 15 patients MRI was performed before and after TIPS, and in 12 patients follistatin serum measurements were carried out. The results on FFMA were confirmed in a validation cohort of 45 patients. FFMA correlated with follistatin and transversal psoas muscle thickness and showed slightly better association with survival than transversal psoas muscle thickness. Gender-specific cutoff values for FFMA were determined for sarcopenia. Decompensation (ascites, overt hepatic encephalopathy) persisted after TIPS in the sarcopenia group but resolved in the nonsarcopenia group. Sarcopenic patients showed no clinical improvement after TIPS as well as higher mortality, mainly due to development of acute-on-chronic liver failure. FFMA was an independent predictor of survival in these patients.

CONCLUSION

This study offers an easy-to-apply MRI-based measurement of fat-free muscle mass as a marker of sarcopenia in decompensated patients; while TIPS might improve sarcopenia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute-on-chronic liver failure development and mortality. (Hepatology 2018;67:1014-1026).

Authors+Show Affiliations

Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Radiology, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Radiology, University of Bonn, Bonn, Germany.Department of Radiology, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Radiology, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany.Division of Gastroenterology, University of Alberta, Alberta, Canada.Department of Radiology, University of Bonn, Bonn, Germany.Department of Internal Medicine I, University of Bonn, Bonn, Germany. Department of Gastroenterology, Odense Hospital, University of Southern Denmark, Odense, Denmark. European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain. Institute for Bioengineering of Catalonia, Barcelona, Spain.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29059469

Citation

Praktiknjo, Michael, et al. "Fat-free Muscle Mass in Magnetic Resonance Imaging Predicts Acute-on-chronic Liver Failure and Survival in Decompensated Cirrhosis." Hepatology (Baltimore, Md.), vol. 67, no. 3, 2018, pp. 1014-1026.
Praktiknjo M, Book M, Luetkens J, et al. Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. Hepatology. 2018;67(3):1014-1026.
Praktiknjo, M., Book, M., Luetkens, J., Pohlmann, A., Meyer, C., Thomas, D., ... Trebicka, J. (2018). Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. Hepatology (Baltimore, Md.), 67(3), pp. 1014-1026. doi:10.1002/hep.29602.
Praktiknjo M, et al. Fat-free Muscle Mass in Magnetic Resonance Imaging Predicts Acute-on-chronic Liver Failure and Survival in Decompensated Cirrhosis. Hepatology. 2018;67(3):1014-1026. PubMed PMID: 29059469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. AU - Praktiknjo,Michael, AU - Book,Marius, AU - Luetkens,Julian, AU - Pohlmann,Alessandra, AU - Meyer,Carsten, AU - Thomas,Daniel, AU - Jansen,Christian, AU - Feist,Andreas, AU - Chang,Johannes, AU - Grimm,Jochen, AU - Lehmann,Jennifer, AU - Strassburg,Christian P, AU - Abraldes,Juan Gonzalez, AU - Kukuk,Guido, AU - Trebicka,Jonel, Y1 - 2018/01/24/ PY - 2017/07/05/received PY - 2017/10/03/revised PY - 2017/10/16/accepted PY - 2017/10/24/pubmed PY - 2018/10/12/medline PY - 2017/10/24/entrez SP - 1014 EP - 1026 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 67 IS - 3 N2 - : Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cutoff values are missing, and most studies have used computed tomography. This study evaluated fat-free muscle area (FFMA) as a marker of sarcopenia using magnetic resonance imaging (MRI) in patients with decompensated cirrhosis with transjugular intrahepatic portosystemic shunt (TIPS). The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the FFMA in 116 patients with cirrhosis by TIPS and MRI. The training cohort of 71 patients compared computed tomography-measured transversal psoas muscle thickness with FFMA. In 15 patients MRI was performed before and after TIPS, and in 12 patients follistatin serum measurements were carried out. The results on FFMA were confirmed in a validation cohort of 45 patients. FFMA correlated with follistatin and transversal psoas muscle thickness and showed slightly better association with survival than transversal psoas muscle thickness. Gender-specific cutoff values for FFMA were determined for sarcopenia. Decompensation (ascites, overt hepatic encephalopathy) persisted after TIPS in the sarcopenia group but resolved in the nonsarcopenia group. Sarcopenic patients showed no clinical improvement after TIPS as well as higher mortality, mainly due to development of acute-on-chronic liver failure. FFMA was an independent predictor of survival in these patients. CONCLUSION: This study offers an easy-to-apply MRI-based measurement of fat-free muscle mass as a marker of sarcopenia in decompensated patients; while TIPS might improve sarcopenia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute-on-chronic liver failure development and mortality. (Hepatology 2018;67:1014-1026). SN - 1527-3350 UR - https://www.unboundmedicine.com/medline/citation/29059469/Fat_free_muscle_mass_in_magnetic_resonance_imaging_predicts_acute_on_chronic_liver_failure_and_survival_in_decompensated_cirrhosis_ L2 - https://doi.org/10.1002/hep.29602 DB - PRIME DP - Unbound Medicine ER -