Sarcopenia Is Associated With Development of Acute-on-Chronic Liver Failure in Decompensated Liver Cirrhosis Receiving Transjugular Intrahepatic Portosystemic Shunt.

Authors:
Michael Praktiknjo
Michael Praktiknjo
Rheinische Friedrich-Wilhelms-Universit├Ąt
Germany
Stefan Fischer
Stefan Fischer
Hannover Medical School
Germany
Christian Jansen
Christian Jansen
University of Bonn
Bonn | Germany
Jennifer Lehmann
Jennifer Lehmann
University of Regensburg
Germany
Barbara Lattanzi
Barbara Lattanzi
Sapienza University of Rome
Italy

Clin Transl Gastroenterol 2019 Apr;10(4):e00025

Department of Internal Medicine I, University of Bonn, Bonn, Germany.

Introduction: Muscle mass has been shown to be a prognostic marker in patients with liver cirrhosis. Transversal psoas muscle thickness normalized by height (TPMT/height) obtained by routine computed tomography is a simple surrogate parameter for sarcopenia. TPMT/height, however, is not sex specific, which might play a role in risk stratification. Its association with acute-on-chronic liver failure (ACLF) has not been established yet. ACLF is associated with systemic inflammatory dysregulation. This study aimed at evaluating the role of sarcopenia in ACLF development of patients with decompensated cirrhosis receiving transjugular intrahepatic portosystemic shunt (TIPS) using sex-specific TPMT/height.

Methods: One hundred eighty-six patients from the prospective Non-invasive Evaluation Program for TIPS and Follow Up Network cohort (observational, real-world TIPS cohort with structured follow-up) were analyzed. TPMT/height was measured from routine computed tomography. The sex-specific cutoff was determined to classify patients as sarcopenic and nonsarcopenic for 1-year mortality after TIPS. Clinical outcome was compared. Primary end points were ACLF and 1-year mortality after TIPS. Secondary end points were development of decompensations (hepatic encephalopathy and ascites) after TIPS.

Results: The sex-specific cutoff increases the diagnostic accuracy with regard to primary and secondary end points compared with the unisex cutoff. Sex-specific sarcopenia classification is an independent predictor of 1-year mortality and ACLF development in patients with cirrhosis receiving TIPS. Patients in the sarcopenia group showed significantly higher rates of mortality, ascites, overt hepatic encephalopathy, and ACLF after TIPS compared with the nonsarcopenia group. The Chronic Liver Failure Consortium Acute Decompensation score as a marker of systemic inflammation was significantly higher in sarcopenic patients.

Conclusions: This study demonstrates for the first time that sarcopenia is related to ACLF development and systemic inflammation. The prognostic value of TPMT/height can be improved by using sex-specific cutoffs. ClinicalTrials.gov identifier: NCT03584204.

Download full-text PDF

Source
http://dx.doi.org/10.14309/ctg.0000000000000025DOI Listing
April 2019
1 Read

Publication Analysis

Top Keywords

cirrhosis receiving
12
1-year mortality
12
aclf development
12
liver failure
12
hepatic encephalopathy
8
intrahepatic portosystemic
8
receiving transjugular
8
transjugular intrahepatic
8
secondary points
8
portosystemic shunt
8
mortality tips
8
development patients
8
sarcopenia aclf
8
systemic inflammation
8
sex-specific cutoff
8
computed tomography
8
routine computed
8
liver cirrhosis
8
acute-on-chronic liver
8
tips
7

Similar Publications