Z Gastroenterol 2020; 58(01): e21
DOI: 10.1055/s-0039-3402156
Poster Visit Session II Clinical Hepatology, Surgery, LTX: Friday, February 14, 2020, 2:40 pm – 3:25 pm, Lecture Hall P1
Georg Thieme Verlag KG Stuttgart · New York

Low muscle mass and large portosystemic shunt in “one-stop shop” CT exponentially increases risk for HE and mortality

J Abu-Omar
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
A Faron
2   University of Bonn, Department of Radiology, Bonn, Germany
,
J Chang
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
N Böhling
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
AM Sprinkart
2   University of Bonn, Department of Radiology, Bonn, Germany
,
C Meyer
2   University of Bonn, Department of Radiology, Bonn, Germany
,
C Strassburg
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
C Jansen
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
,
J Trebicka
3   University of Frankfurt, Department of Internal Medicine 1, Frankfurt, Germany
4   European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
,
J Luetkens
2   University of Bonn, Department of Radiology, Bonn, Germany
,
M Praktiknjo
1   University of Bonn, Department of Internal Medicine I, Bonn, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2020 (online)

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    Background:

    Sarcopenia and spontaneous portosystemic shunts are common complications of liver cirrhosis and both are associated with higher rates of hepatic encephalopathy (HE) development in these patients. This study aimed to evaluate the simultaneous impact of skeletal muscle mass and spontaneous portosystemic shunting, measured from routine diagnostic computed tomography (CT), on outcome in patients with liver cirrhosis.

    Methods:

    Consecutive patients with liver cirrhosis presenting to our center were retrospectively evaluated. Skeletal muscle mass (including fat-free muscle index (FFMI) as surrogate for sarcopenia) and total cross-sectional spontaneous portosystemic shunt area (TSA) were quantified from available CT scans. Primary endpoint was development of HE, secondary endpoint was all-cause mortality within 1-year follow-up.

    Results:

    Among 209 patients included, patients with low (L-)FFMI and large (L-)TSA showed higher rates of HE development. In multivariable analysis, L-FFMI and L-TSA were independent predictors of HE development (L-FFMI HR = 2.68; L-TSA HR = 2.48) and 1-year mortality (L-FFMI, HR = 7.68; L-TSA, HR = 3.05). Simultaneous presence of L-FFMI and L-TSA exponentially increased the risk of HE development (HR = 12.7) and 1-year mortality (HR = 13.66).

    Conclusion:

    This study is the first to indicate a potential synergy between low skeletal muscle mass and large portosystemic shunting to predict exponentially increased risk of HE development and mortality in liver cirrhosis. Simultaneous opportunistic screening for sarcopenia and portosystemic shunt area from routine diagnostic CT may help to improve identification of high-risk patients.


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