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The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis.
Liver Int. 2019 12; 39(12):2374-2385.LI

Abstract

BACKGROUND & AIMS

Low muscle mass impacts on morbidity and mortality in cirrhosis. The skeletal-muscle index (SMI) is a well-validated tool to diagnose muscle wasting, but requires specialized radiologic software and expertise. Thus, we compared different Computed tomography (CT)-based evaluation methods for muscle wasting and their prognostic value in cirrhosis.

METHODS

Consecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analysed. SMI, transversal psoas muscle thickness (TPMT), total psoas volume (TPV) and paraspinal muscle index (PSMI) were measured. Sarcopenia was defined using SMI as a reference method by applying sex-specific cut-offs (males: <52.4 cm2 /m2 ; females: <38.5 cm2 /m2).

RESULTS

One hundred and nine patients (71.6% male) of age 57 ± 11 years, MELD 16 (8-26) and alcoholic liver disease (63.3%) as the main aetiology were included. According to established SMI cut-offs, low muscle mass was present in 69 patients (63.3%) who also presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex-specific cut-offs (men/women) for diagnosing low muscle mass were determined: TPMT: <10.7/ <7.8 mm/m, TPV: <194.9/ <99.2 cm3 and PSMI <26.3/ <20.8 cm2 /m2 . Thirty (27.5%) patients died during a follow-up of 15 (0.3-45.7) months. Univariate competing risks analyses showed a significant risk for mortality according to SMI (aSHR:2.52, 95% CI: 1.03-6.21, P = .043), TPMT (aSHR: 3.87, 95% CI: 1.4-8.09, P = .007) and PSMI (aSHR: 2.7, 95% CI: 1.17-6.23, P = .02), but not TPV (P = .18) derived low muscle mass cut-offs. In multivariate analysis only TPMT (aSHR: 2.82, 95% CI: 1.20-6.67, P = .018) was associated with mortality, SMI (aSHR: 1.93, 95% CI: 0.72-5.16, P = .19) and PSMI (aSHR: 1.93, 95% CI: 0.79-4.75, P = .15) were not.

CONCLUSION

Low muscle mass was highly prevalent in our cohort of patients with cirrhosis. Gender-specific TPMT, SMI and PSMI cut-offs for low muscle mass can help identify patients with an increased risk for mortality. Importantly, only TPMT emerged as an independent risk factor for mortality in patients with cirrhosis.

Authors+Show Affiliations

Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Divison of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria. Department of Medicine I, Hospital St. John of God, Vienna, Austria.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31421002

Citation

Paternostro, Rafael, et al. "The Value of Different CT-based Methods for Diagnosing Low Muscle Mass and Predicting Mortality in Patients With Cirrhosis." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 39, no. 12, 2019, pp. 2374-2385.
Paternostro R, Lampichler K, Bardach C, et al. The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. Liver Int. 2019;39(12):2374-2385.
Paternostro, R., Lampichler, K., Bardach, C., Asenbaum, U., Landler, C., Bauer, D., Mandorfer, M., Schwarzer, R., Trauner, M., Reiberger, T., & Ferlitsch, A. (2019). The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. Liver International : Official Journal of the International Association for the Study of the Liver, 39(12), 2374-2385. https://doi.org/10.1111/liv.14217
Paternostro R, et al. The Value of Different CT-based Methods for Diagnosing Low Muscle Mass and Predicting Mortality in Patients With Cirrhosis. Liver Int. 2019;39(12):2374-2385. PubMed PMID: 31421002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. AU - Paternostro,Rafael, AU - Lampichler,Katharina, AU - Bardach,Constanze, AU - Asenbaum,Ulrika, AU - Landler,Clara, AU - Bauer,David, AU - Mandorfer,Mattias, AU - Schwarzer,Remy, AU - Trauner,Michael, AU - Reiberger,Thomas, AU - Ferlitsch,Arnulf, Y1 - 2019/09/11/ PY - 2019/02/13/received PY - 2019/06/04/revised PY - 2019/07/30/accepted PY - 2019/8/20/pubmed PY - 2020/10/6/medline PY - 2019/8/18/entrez KW - cirrhosis KW - mortality KW - psoas KW - sarcopenia KW - skeletal-muscle index SP - 2374 EP - 2385 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int VL - 39 IS - 12 N2 - BACKGROUND & AIMS: Low muscle mass impacts on morbidity and mortality in cirrhosis. The skeletal-muscle index (SMI) is a well-validated tool to diagnose muscle wasting, but requires specialized radiologic software and expertise. Thus, we compared different Computed tomography (CT)-based evaluation methods for muscle wasting and their prognostic value in cirrhosis. METHODS: Consecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analysed. SMI, transversal psoas muscle thickness (TPMT), total psoas volume (TPV) and paraspinal muscle index (PSMI) were measured. Sarcopenia was defined using SMI as a reference method by applying sex-specific cut-offs (males: <52.4 cm2 /m2 ; females: <38.5 cm2 /m2). RESULTS: One hundred and nine patients (71.6% male) of age 57 ± 11 years, MELD 16 (8-26) and alcoholic liver disease (63.3%) as the main aetiology were included. According to established SMI cut-offs, low muscle mass was present in 69 patients (63.3%) who also presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex-specific cut-offs (men/women) for diagnosing low muscle mass were determined: TPMT: <10.7/ <7.8 mm/m, TPV: <194.9/ <99.2 cm3 and PSMI <26.3/ <20.8 cm2 /m2 . Thirty (27.5%) patients died during a follow-up of 15 (0.3-45.7) months. Univariate competing risks analyses showed a significant risk for mortality according to SMI (aSHR:2.52, 95% CI: 1.03-6.21, P = .043), TPMT (aSHR: 3.87, 95% CI: 1.4-8.09, P = .007) and PSMI (aSHR: 2.7, 95% CI: 1.17-6.23, P = .02), but not TPV (P = .18) derived low muscle mass cut-offs. In multivariate analysis only TPMT (aSHR: 2.82, 95% CI: 1.20-6.67, P = .018) was associated with mortality, SMI (aSHR: 1.93, 95% CI: 0.72-5.16, P = .19) and PSMI (aSHR: 1.93, 95% CI: 0.79-4.75, P = .15) were not. CONCLUSION: Low muscle mass was highly prevalent in our cohort of patients with cirrhosis. Gender-specific TPMT, SMI and PSMI cut-offs for low muscle mass can help identify patients with an increased risk for mortality. Importantly, only TPMT emerged as an independent risk factor for mortality in patients with cirrhosis. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/31421002/The_value_of_different_CT_based_methods_for_diagnosing_low_muscle_mass_and_predicting_mortality_in_patients_with_cirrhosis_ L2 - https://doi.org/10.1111/liv.14217 DB - PRIME DP - Unbound Medicine ER -