Kosin Med J.  2020 Dec;35(2):133-142. 10.7180/kmj.2020.35.2.133.

Usefulness of Psoas Muscle Cross-Sectional Area in Evaluating Physical Performance in Patients with Liver Cirrhosis

• Jang BS
• Choi HE
• Lee JH
• Sim YJ
• Kim GC
• Jeong HJ

• KMID: 2510274
• DOI: http://doi.org/10.7180/kmj.2020.35.2.133

Abstract

Objectives
To investigate the relationship between the psoas muscle cross-sectional area and physical performance in patients with liver cirrhosis.
Methods
This study analyzed ambulatory patients with liver cirrhosis aged < 65 years, who underwent abdominal computed tomography (CT) and Short Physical Performance Battery (SPPB) tests from December 2018 to December 2019. A total of 46 patients (36 men, 10 women) were included. In abdominal CT scans, the psoas muscle cross-sectional area (mm² ) was measured at the distal end-plate level of the L4 vertebral body and normalized by dividing by height (m). Physical performance was evaluated using SPPB. A correlation analysis between the psoas muscle cross-sectional area and SPPB was performed. Kruskal-Wallis test was used to determine differences in the psoas muscle cross-sectional area and SPPB according to the Child-Pugh classification. Multiple regression analysis was performed to determine factors affecting SPPB.
Results
The correlation coefficient between the psoas muscle cross-sectional area and SPPB was 0.459 at the P < 0.01 level. No difference was observed in the psoas muscle cross-sectional area and SPPB according to the Child-Pugh classification. The psoas muscle cross-sectional area was a factor affecting SPPB in multiple regression analysis.
Conclusions
Abdominal CT is an essential diagnostic tool in patients with liver cirrhosis. Ambulatory patients with liver cirrhosis aged < 65 years could have reduced physical performance. In this study, the psoas muscle cross-sectional area was correlated with physical performance and was a factor affecting physical performance. The psoas muscle cross-sectional area and physical performance should be evaluated in patients with liver cirrhosis.

Keyword

Liver cirrhosis; Physical performance; Psoas muscles

Figure

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  Fig. 1 Measurement of the psoas muscle cross-sectional area (arrow) at the distal end-plate level of the L4 vertebral body.

Reference

1. Schuppand D, Afdhal NH. Liver cirrhosis. Lancet. 2008; 371:838–51.

2. Kalafateli M, Konstantakis C, Thomopoulos K, Triantos C. Impact of muscle wasting on survival in patients with liver cirrhosis. World J Gasteroenterol. 2015; 21:7357–61.

3. Kim HY, Jang JW. Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. World J Gastroenterol. 2015; 21:7637–47.

4. Tsien C, Shah SN, McMullough AJ, Dasarathy S. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastroenterol Hepatol. 2013; 25:85–93.

5. Englesbe MJ, Patel SP, He K, Lynch Rj, Schaubel DE, Harbaugh C, et al. Sarcopenia and Mortality After Liver Transplantation. J Am Coll Surg. 2010; 211:271–8.

6. Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gasteroenterol. 2014; 20:8061–71.

7. Gu DH, Kim MY, Seo YS, Kim SG, Lee HA, Kim TH, et al. Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis. Clinic Mol Hepatol. 2018; 24:319–30.

8. Marie S, Eduard P, Jennifer LD, Jennifer CL. Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist. World J Gastroenterol. 2017; 23:899–905.

9. Jennifer CL, Kenneth EC, Jennifer LD, John B, Dorry LS, John PR, et al. Development of a novel frailty index to predict mortality in patiens with end-stage liver disease. Hepatology. 2017; 66:564–74.

10. Durand F, Valla D. Assessment of prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol. 2005; 42:S100–7.

11. Reid JG, Livingston LA, Pearsall DJ. The geometry of the psoas muscle as determined by magnetic resonance imaging. Arch Phys Med Rehabil. 1994; 75:703–8.

12. Cruz-jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010; 39:412–23.

13. Silva M, Gomes S, Peixoto A, Ramalho PT, Cardoso H, Azevedo R, et al. Nutrition in chronic liver disease. GE Port J Gastroenterol. 2015; 22:268–76.

14. Kim TY, Kim MY, Sohn JH, Kim SM, Ryu JA, Lim SH, et al. Sarcopenia as a useful predictor for long term mortality in cirrhotic patients with ascites. J Korean Med Sci. 2014; 29:1253–9.

15. Imamura K, Ashida H, Ishikawa T, Fuiji M. Human major psoas muscle and sacrospinalis muscle in relation to age: a study by computed tomography. J Gereontol. 1983; 38:678–81.

16. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014; 15:95–101.

17. Kim KE, Jang SN, Lim S, Park YJ, Paik NJ, Kim KW, et al. Relationship between muscle mass and physical performance: is it the same in older adults with weak muscle strength? Age Ageing. 2012; 41:799–803.

18. Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010; 1:129–33.

19. Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med. 2016; 9:229–55.

20. Alber AB, Suter DM. Dynamics of protein synthesis and degradation through the cell cycle. Cell cycle. 2019; 18:784–94.

21. Huang SW, Hsieh FC, Lin LF, Liao CD, Ku JW, Hsiao DJ, et al. Correlation between Body Composition and Physical Performance in Aged People. Int J Gastroenterol. 2018; 12:186–90.

22. Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33:997–1006.

23. Antonio J, Kenyon M, Ellerbroek A, Carson C, Burgess V, Tyler-Palmer D, et al. Comparison of dual energy x-ray absorptiometry versus a multi frequency bioelectrical impedance device for body composition assessment after a 4-week hypoenergetic diet. Funct Morphol Kinesiol. 2019; 4:23.