J Korean Med Sci.  2014 Sep;29(9):1253-1259. 10.3346/jkms.2014.29.9.1253.

Sarcopenia as a Useful Predictor for Long-Term Mortality in Cirrhotic Patients with Ascites

• Kim TY
• Kim MY
• Sohn JH
• Kim SM
• Ryu JA
• Lim S
• Kim Y

• KMID: 1794604
• DOI: http://doi.org/10.3346/jkms.2014.29.9.1253

Abstract

This study aimed to assess and compare sarcopenia with other prognostic factors for predicting long-term mortality in cirrhotic patients with ascites. Clinical data of 65 among 89 patients with measurement of all parameters were consecutively collected. Sarcopenia was evaluated as right psoas muscle thickness measurement divided by height (PMTH) (mm/m). During a mean follow-up of 20 (range: 1-49) months, 19 (29.2%) of 65 patients died. The values of the area under the receiver operating characteristics curve (AUROC) of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na, and PMTH for predicting 1-yr mortality were 0.777 (95% CI, 0.635-0.883), 0.769 (95% CI, 0.627-0.877), 0.800 (95% CI, 0.661-0.900), and 0.833 (95% CI, 0.699-0.924), whereas hepatic venous pressure gradient was not significant (AUROC, 0.695; 95% CI. 0.547-0.818, P=0.053). The differences between PMTH and other prognostic variables were not significant (all P>0.05). The best cut-off value of PMTH to predict long-term mortality was 14 mm/m. The mortality rates at 1-yr and 2-yr with PMTH>14 mm/m vs. PMTH< or =14 mm/m were 2.6% and 15.2% vs. 41.6% and 66.8%, respectively (P<0.001). The mortality in cirrhotic patients with PMTH< or =14 mm/m was higher than those with PMTH>14 mm/m (HR, 5.398; 95% CI, 2.111-13.800, P<0.001). In conclusion, sarcopenia, evaluated by PMTH, is an independent useful predictor for long-term mortality in cirrhotic patients with ascites.

Keyword

Ascites; Liver Cirrhosis; Prognosis; Psoas Muscle Thickness; Sarcopenia

MeSH Terms

Adult
Aged
Area Under Curve
*Ascites
Female
Follow-Up Studies
Humans
Liver Cirrhosis/complications/*mortality
Male
Middle Aged
Predictive Value of Tests
Prognosis
ROC Curve
Regression Analysis
Sarcopenia/*diagnosis/etiology/radiography
Severity of Illness Index
Survival Analysis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Patient enrollment diagram. CT, computed tomography; HVPG; hepatic venous pressure gradient.

• 

  Fig. 2 Examples of measurement of psoas muscle thickness at the level of endplate of L4 on an axial CT scan image. (A) A healthy control (male, 60 yr old) had PMTH of 26 mm/m. (B) A cirrhotic patient (female, 52) with viral hepatitis B had CP score of 12, MELD score of 19, MELD-Na of 19, HVPG 19 mmHg and PMTH of 19 mm/m. This case showed longer survival of 40 months after PMTH measurement. (C) A cirrhotic patient (male, 70) with viral hepatitis B had CP score of 8, MELD score of 8, MELD-Na of 8, HVPG of 14 mmHg and PMTH of 11 mm/m. This case resulted in earlier death from septic shock 3 months after CT examination. PMTH, psoas muscle thickness by height.

• 

  Fig. 3 The AUROCs of various prognostic predictors for 1-year mortality in cirrhotic patients with ascites. The AUROCs of CP score, MELD score, MELD-Na, and PMTH were 0.777, 0.769, 0.800, and 0.833, respectively (all P < 0.01), whereas AUROC of HVPG was 0.695 (P = 0.053). The differences between PMTH and other prognostic variables were not significant. AUROC, area under the receiver operating characteristics curve; CP, Child-Pugh; HVPG, hepatic venous pressure gradient; MELD, Model for End-Stage Liver Disease; MELD-Na, serum sodium to MELD score; PMTH, psoas muscle thickness by height.

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  Fig. 4 Survival curves in cirrhotic patients with ascites by 14 mm/m cutoff value of PMTH. PMTH, psoas muscle thickness by height.

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