PROGNOSTIC IMPACTS OF THE CHANGE IN MUSCLE MASS ON PATIENTS WITH CIRRHOSIS

Abstract

Background: It is known that sarcopenia is significantly associated with the mortality and occurrence of complications of patients with cirrhosis. However, muscle mass can change, and it is not yet known how these changes affect the clinical course of patients with cirrhosis.

Methods: Among prospective cohort of patients with cirrhosis who had received the abdomen CT annually for HCC surveillance, those who underwent two or more CT scans were included. L3 skeletal muscle index (SMI) was adopted as a proxy of skeletal muscle mass, and we calculated a change of SMI between baseline and one-year (∆SMI/yr). Cirrhotic complications included ascites aggravation, spontaneous bacterial peritonitis, overt encephalopathy and variceal bleeding.

Results: In a total of 306 patients, 78 and 36 had sarcopenia and Child-Pugh class B/C decompensation, respectively. During a median follow-up of 36 months, 23 patients died and 32 had undergone complications of cirrhosis. Multivariate Cox regression analyses showed only Child-Pugh score and MELD score at 1-year were associated with survival. However, ∆SMI/yr was associated with complication occurrence even after adjusted for Child-Pugh or MELD score at 1-year. The effect differed according to sex, and 1% decrease in ∆SMI/yr accelerated 1.05 and 1.27-fold occurrence of complication in male and female, respectively. In addition, ∆SMI/yr showed good prediction of occurrence of complication, with a cut-off of -2.62% (sensitivity 73.9%, specificity 76.3%).

Conclusion: ∆SMI/yr was significantly associated with the occurrence of cirrhotic complications of patients with cirrhosis, independently with Child-Pugh and MELD scores at 1-year.