Abstract：
The role of sarcopenia in predicting decompensation other than hepatic encephalopathy is unclear. We aimed to evaluate the prognostic role of sarcopenia, assessed by computed tomography (CT), in the development of ascites and mortality in patients with advanced chronic liver disease (ACLD) outside the liver transplantation (LT) setting.
We retrospectively evaluated ACLD patients with liver stiffness measurement (LSM) >10 kPa and an available CT scan within 6 months. Sarcopenia was defined as skeletal muscle index (SMI) <50 and <39 cm2/m2, respectively, in men and women. Competing risk regression models were used to assess the variables associated with the main outcomes.
209 patients were included in the final analysis and sarcopenia was present in 134 (64.1%). During a median follow-up of 37 (20-63) months, 52 patients developed ascites, 24 underwent LT, and 30 died. Sarcopenia was found a predictive factor of decompensation with ascites (SHR 2.083, 95%-CI: 1.091-3.978), independently from the features of clinically significant portal hypertension (LSM≥21 kPa or portosystemic shunts). Sarcopenia (SHR: 2.744, 95%-CI: 1.105-6.816) and LSM≥21 kPa (SHR: 3.973, 95%-CI: 1.548-10.197) were independent risk factors for increased mortality.
Sarcopenia and portal hypertension are two major and independent risk factors for decompensation with ascites and mortality in cirrhotic patients outside the LT context.
We retrospectively evaluated ACLD patients with liver stiffness measurement (LSM) >10 kPa and an available CT scan within 6 months. Sarcopenia was defined as skeletal muscle index (SMI) <50 and <39 cm2/m2, respectively, in men and women. Competing risk regression models were used to assess the variables associated with the main outcomes.
209 patients were included in the final analysis and sarcopenia was present in 134 (64.1%). During a median follow-up of 37 (20-63) months, 52 patients developed ascites, 24 underwent LT, and 30 died. Sarcopenia was found a predictive factor of decompensation with ascites (SHR 2.083, 95%-CI: 1.091-3.978), independently from the features of clinically significant portal hypertension (LSM≥21 kPa or portosystemic shunts). Sarcopenia (SHR: 2.744, 95%-CI: 1.105-6.816) and LSM≥21 kPa (SHR: 3.973, 95%-CI: 1.548-10.197) were independent risk factors for increased mortality.
Sarcopenia and portal hypertension are two major and independent risk factors for decompensation with ascites and mortality in cirrhotic patients outside the LT context.
摘要：
背景：肌少症在预测肝性脑病以外的代偿失调中的作用尚不清楚。我们旨在评估肌肉减少症的预后作用，通过计算机断层扫描（CT）评估，在肝移植（LT）设置之外的晚期慢性肝病（ACLD）患者的腹水发展和死亡率。
方法：我们回顾性评估了ACLD患者的肝脏硬度测量（LSM）>10kPa，并在6个月内进行了CT扫描。肌少症定义为骨骼肌指数(SMI)分别<50和<39cm2/m2,在男人和女人。使用竞争风险回归模型来评估与主要结果相关的变量。
结果：209例患者被纳入最终分析，134例（64.1%）出现肌肉减少症。在37（20-63）个月的中位随访中，52例患者出现腹水，24接受LT，30人死亡。发现肌肉减少症是腹水代偿失调的预测因素（SHR2.083，95％-CI：1.091-3.978），独立于具有临床意义的门静脉高压症（LSM≥21kPa或门体分流）的特征。肌肉减少症（SHR：2.744，95％-CI：1.105-6.816）和LSM≥21kPa（SHR：3.973，95％-CI：1.548-10.197）是死亡率增加的独立危险因素。
结论：肌肉减少症和门脉高压是LT外肝硬化患者代偿失调和死亡的两个主要和独立的危险因素。
方法：我们回顾性评估了ACLD患者的肝脏硬度测量（LSM）>10kPa，并在6个月内进行了CT扫描。肌少症定义为骨骼肌指数(SMI)分别<50和<39cm2/m2,在男人和女人。使用竞争风险回归模型来评估与主要结果相关的变量。
结果：209例患者被纳入最终分析，134例（64.1%）出现肌肉减少症。在37（20-63）个月的中位随访中，52例患者出现腹水，24接受LT，30人死亡。发现肌肉减少症是腹水代偿失调的预测因素（SHR2.083，95％-CI：1.091-3.978），独立于具有临床意义的门静脉高压症（LSM≥21kPa或门体分流）的特征。肌肉减少症（SHR：2.744，95％-CI：1.105-6.816）和LSM≥21kPa（SHR：3.973，95％-CI：1.548-10.197）是死亡率增加的独立危险因素。
结论：肌肉减少症和门脉高压是LT外肝硬化患者代偿失调和死亡的两个主要和独立的危险因素。
