Z Gastroenterol 2019; 57(05): e153
DOI: 10.1055/s-0039-1691911
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

The value of different CT-based methods for diagnosing sarcopenia and predicting mortality in patients with cirrhosis

R Paternostro
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
K Lampichler
2   Department of Radiology, Medical University of Vienna, Vienna, Austria
,
C Bardach
2   Department of Radiology, Medical University of Vienna, Vienna, Austria
,
U Asenbaum
2   Department of Radiology, Medical University of Vienna, Vienna, Austria
,
C Landler
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
M Mandorfer
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
R Schwarzer
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
M Trauner
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
T Reiberger
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
A Ferlitsch
1   Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

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Background&Aims:

Sarcopenia impacts on morbidity and mortality in cirrhosis. The skeletal-muscle-index (SMI) is a well-validated tool to diagnose sarcopenia, but requires specialized radiologic software and expertise. Thus, we compared different CT-based evaluation methods for sarcopenia and their prognostic value in cirrhosis.

Methods:

Consecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analyzed. Skeletal muscle index (SMI), transversal psoas muscle thickness (TPMT), total psoas volume (TPV) and paraspinal muscle index (PSMI) were measured. Sarcopenia was defined using SMI as a reference method by applying sex-specific cut-offs (males:< 52.4 cm2/m2; females:< 38.5 cm2/m2).

Results:

109 patients (71.6% male) with a mean age of 57 ± 11 years, a median MELD of 16 (8 – 26), and alcoholic liver disease (63.3%) as the main etiology were included. According to established SMI cut-offs, sarcopenia was present in 69 patients (63.3%) who also presented with higher MELD (17 vs. 14 points; p = 0.025). The following optimal sex-specific cut-offs (men/women) for diagnosing sarcopenia were determined: TPMT:< 10.7/< 7.8 mm/m, TPV:< 194.9/< 99.2 cm3, and PSMI< 26.3/< 20.8 cm2/m2. 30 (27.5%) patients died during a median follow-up of 15 (0.3 – 45.7) months. We observed shorter survival in patients with sarcopenia as defined by SMI [41.4 months (35.2 – 47.5) vs. 33.5 m (27.7 – 39.4), p = 0.045] and by TPMT [42.6 m (37.4 – 47.8) vs. 32.1 m (26 – 38.3), p = 0.008], but not by PSMI (p = 0.074) and by TPV (p = 0.201). Cox regression analyses adjusted for age, MELD, albumin, ascites and either SMI or TPMT, identified only TPMT (HR: 2.51, 95% confidence interval (CI): 1.01 – 6.23; p = 0.047) as an independent risk factor for mortality.

Conclusion:

Sarcopenia was highly prevalent in our cohort of patients with cirrhosis. Gender-specific SMI and TPMT cut-offs for sarcopenia can identify patients with shorter transplant-free survival. Importantly, low TPMT emerged as an independent risk factor for mortality in patients with cirrhosis.