Z Gastroenterol 2019; 57(01): e3-e4
DOI: 10.1055/s-0038-1677141
Lectures Session 2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Presence of sarcopenia is associated with development of acute-on-chronic liver failure in the NEPTUN cohort

M Praktiknjo
1   University Hospital Bonn, Germany
,
C Clees
1   University Hospital Bonn, Germany
,
A Pigliacelli
2   Sapienza University of Rome, Italy
,
S Fischer
1   University Hospital Bonn, Germany
,
C Jansen
1   University Hospital Bonn, Germany
,
J Lehmann
1   University Hospital Bonn, Germany
,
A Pohlmann
1   University Hospital Bonn, Germany
,
B Lattanzi
2   Sapienza University of Rome, Italy
,
V Krabbe
1   University Hospital Bonn, Germany
,
CP Strassburg
1   University Hospital Bonn, Germany
,
V Arroyo
3   European Foundation for the Study of Chronic Liver Failure
,
M Merli
2   Sapienza University of Rome, Italy
,
J Trebicka
4   University Hospital of Frankfurt, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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    Background:

    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 (CT) is a simple surrogate parameter for sarcopenia. TPMT/height, however, is not gender-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 inflammation. This study aimed to evaluate the role of sarcopenia in ACLF development of decompensated cirrhotic patients receiving transjugular intrahepatic portosystemic shunt (TIPS) using gender-specific TPMT/height.

    Methods:

    186 patients from the prospective NEPTUN cohort (observational, real-world TIPS cohort with structured follow up) were analyzed. TPMT/height was measured from routine CT scans. Gender-specific cut-off was determined to classify patients as sarcopenic and non-sarcopenic for 1-year mortality after TIPS. Clinical outcome was compared. Primary endpoints were ACLF and 1-year mortality after TIPS. Secondary endpoints were development of decompensations (hepatic encephalopathy and ascites) after TIPS.

    Results:

    Gender-specific cut-off increases the diagnostic accuracy with regard to primary and secondary endpoint compared to unisex cut-off. Gender-specific sarcopenia classification is an independent predictor of 1-year mortality and ACLF development in cirrhotic patients receiving TIPS. Patients in the sarcopenia group showed significantly higher rates of mortality, ascites, overt hepatic encephalopathy and ACLF after TIPS compared to the non-sarcopenia group. CLIF-C AD score as prognostic marker and reflection of systemic inflammation was significantly higher in sarcopenic patients.

    Conclusion:

    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 gender-specific cut-offs. ClinicalTrials.gov identifier: NCT03584204.


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