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Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis.
Hepatol Int. 2018 Jul; 12(4):377-386.HI

Abstract

BACKGROUND

Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis.

PURPOSE

The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality.

METHODS

A total of 675 cirrhotic patients were studied. Computed tomography scans were used to analyze the skeletal muscle. Hepatic encephalopathy was defined by either a hepatic encephalopathy-related hospitalization and/or taking ammonia-lowering treatment (i.e., lactulose, rifaximin).

RESULTS

Myosteatosis was observed in 348 patients (52%), sarcopenia in 242 (36%), and hepatic encephalopathy in 128 (19%) patients. Both myosteatosis (70 vs. 45%, p < 0.001) and sarcopenia (53 vs. 32%, p < 0.001) were more frequent in patients with hepatic encephalopathy. By multivariable regression analysis, both myosteatosis and sarcopenia were associated with a higher risk of hepatic encephalopathy, independent of the MELD score (OR 2.25; 95% CI, 1.32-3.85, p = 0.003 and OR 2.42; 95% CI, 1.43-4.10, p = 0.001, respectively). In univariate Cox proportional hazards analysis, sarcopenia (csHR 2.02; 95% CI, 1.57-2.58, p < 0.001), myosteatosis (csHR 1.45; 95% CI, 1.16-2.91, p = 0.004), and hepatic encephalopathy (csHR 1.61; 95% CI, 1.20-2.18, p = 0.002) were associated with mortality, but only sarcopenia was significant in the multivariable analysis (csHR 2.15; 95% CI, 1.52-3.05, p < 0.001).

CONCLUSIONS

Myosteatosis and sarcopenia are independently associated with overt hepatic encephalopathy in patients with cirrhosis. The association between hepatic encephalopathy and mortality may be explained at least partially by the presence of sarcopenia. These results identify the importance of muscle mass and suggest therapeutic strategies to attenuate muscle mass loss and improve muscle quality.

Authors+Show Affiliations

Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, AB, T6G 2X8, Canada.Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, AB, T6G 2X8, Canada.Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, AB, T6G 2X8, Canada.Department of Oncology, Cross Cancer Institute, Edmonton, AB, Canada.Department of Medicine, Université de Montréal CRCHUM, Montréal, QC, Canada.Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, 8540 112 Street NW, Zeidler Ledcor Centre, Room 1-20B, Edmonton, AB, T6G 2X8, Canada. montanol@ualberta.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29881992

Citation

Bhanji, Rahima A., et al. "Myosteatosis and Sarcopenia Are Associated With Hepatic Encephalopathy in Patients With Cirrhosis." Hepatology International, vol. 12, no. 4, 2018, pp. 377-386.
Bhanji RA, Moctezuma-Velazquez C, Duarte-Rojo A, et al. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatol Int. 2018;12(4):377-386.
Bhanji, R. A., Moctezuma-Velazquez, C., Duarte-Rojo, A., Ebadi, M., Ghosh, S., Rose, C., & Montano-Loza, A. J. (2018). Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatology International, 12(4), 377-386. https://doi.org/10.1007/s12072-018-9875-9
Bhanji RA, et al. Myosteatosis and Sarcopenia Are Associated With Hepatic Encephalopathy in Patients With Cirrhosis. Hepatol Int. 2018;12(4):377-386. PubMed PMID: 29881992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. AU - Bhanji,Rahima A, AU - Moctezuma-Velazquez,Carlos, AU - Duarte-Rojo,Andres, AU - Ebadi,Maryam, AU - Ghosh,Sunita, AU - Rose,Christopher, AU - Montano-Loza,Aldo J, Y1 - 2018/06/07/ PY - 2017/10/13/received PY - 2018/05/24/accepted PY - 2018/6/9/pubmed PY - 2019/5/23/medline PY - 2018/6/9/entrez KW - Hepatic encephalopathy KW - Liver cirrhosis KW - Liver transplantation KW - Nutrition SP - 377 EP - 386 JF - Hepatology international JO - Hepatol Int VL - 12 IS - 4 N2 - BACKGROUND: Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis. PURPOSE: The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality. METHODS: A total of 675 cirrhotic patients were studied. Computed tomography scans were used to analyze the skeletal muscle. Hepatic encephalopathy was defined by either a hepatic encephalopathy-related hospitalization and/or taking ammonia-lowering treatment (i.e., lactulose, rifaximin). RESULTS: Myosteatosis was observed in 348 patients (52%), sarcopenia in 242 (36%), and hepatic encephalopathy in 128 (19%) patients. Both myosteatosis (70 vs. 45%, p < 0.001) and sarcopenia (53 vs. 32%, p < 0.001) were more frequent in patients with hepatic encephalopathy. By multivariable regression analysis, both myosteatosis and sarcopenia were associated with a higher risk of hepatic encephalopathy, independent of the MELD score (OR 2.25; 95% CI, 1.32-3.85, p = 0.003 and OR 2.42; 95% CI, 1.43-4.10, p = 0.001, respectively). In univariate Cox proportional hazards analysis, sarcopenia (csHR 2.02; 95% CI, 1.57-2.58, p < 0.001), myosteatosis (csHR 1.45; 95% CI, 1.16-2.91, p = 0.004), and hepatic encephalopathy (csHR 1.61; 95% CI, 1.20-2.18, p = 0.002) were associated with mortality, but only sarcopenia was significant in the multivariable analysis (csHR 2.15; 95% CI, 1.52-3.05, p < 0.001). CONCLUSIONS: Myosteatosis and sarcopenia are independently associated with overt hepatic encephalopathy in patients with cirrhosis. The association between hepatic encephalopathy and mortality may be explained at least partially by the presence of sarcopenia. These results identify the importance of muscle mass and suggest therapeutic strategies to attenuate muscle mass loss and improve muscle quality. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/29881992/Myosteatosis_and_sarcopenia_are_associated_with_hepatic_encephalopathy_in_patients_with_cirrhosis_ L2 - https://dx.doi.org/10.1007/s12072-018-9875-9 DB - PRIME DP - Unbound Medicine ER -