A multicenter study to define sarcopenia in patients with end-stage liver disease
Open accessAbstract
Sarcopenia is associated with increased wait‐list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end‐stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross‐sectional area (cm 2 ) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait‐list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex‐specific potential cutoff values to define sarcopenia were determined with a grid search guided by log‐rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm 2 /m 2 : 50.0 in men and 42.0 in women. At a median of 8.8 months follow‐up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm 2 /m 2 ; P < 0.001), and SMI was associated with wait‐list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm 2 /m 2 for men and 39 cm 2 /m 2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm 2 /m 2 for men and < 39 cm 2 /m 2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625–633 2017 AASLD .
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The use of cut-off values for sarcopenia established in patients without obesity is a limitation.
“the use of cut-off values for sarcopenia established in patients without obesity 29”
From Muscle fat content is strongly associated with NASH: a longitudinal study in patients with morbid obesity (2021) · cites this paper as [29]
The skeletal muscle index cutoff determines the numerical definition of sarcopenia by showing a clear survival difference in patients with end-stage liver disease.
“This cutoff value determines the numerical definition of sarcopenia by showing a clear survival difference in patients with end-stage liver disease.”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [22]
Carey et al. identified and defined the skeletal muscle index with cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women.
“Recently, Carey et al. identified and defined the skeletal muscle index (SMI) (SMI cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women) [22].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [22]
Cutoff values defining sarcopenia derived from patients with cirrhosis on the LT list and based on clinical outcomes have recently been suggested (50 cm2/m2 for men and 39 cm2/m2 for women).
“Cutoff values defining sarcopenia derived from patients with cirrhosis on the LT list and based on clinical outcomes have recently been suggested (50 cm2/m2 for men and 39 cm2/m2 for women) [22].”
From Bone diseases in patients with chronic liver disease (2019) · cites this paper as [22]
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Cites
Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia
Chen, L.-K., Liu, L.-K., Woo, J., Assantachai, P., Auyeung, T.-W., Bahyah, K. S., Chou, M.-Y., Chen, L.-Y., Hsu, P.-S., Krairit, O., et al. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.11.025 · Cited by 4,051 · see citing works
Prado, C. M., Lieffers, J. R., McCargar, L. J., Reiman, T., Sawyer, M. B., Martin, L., & Baracos, V. E. (2008) · The Lancet Oncology · doi:10.1016/s1470-2045(08)70153-0 · Cited by 3,238 · see citing works
Martin, L., Birdsell, L., Macdonald, N., Reiman, T., Clandinin, M. T., McCargar, L. J., Murphy, R. A., Ghosh, S., Sawyer, M. B., & Baracos, V. E. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2012.45.2722 · Cited by 2,698 · see citing works
Shen, W., Punyanitya, M., Wang, Z., Gallagher, D., St.-Onge, M.-P., Albu, J., Heymsfield, S. B., & Heshka, S. (2004) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00744.2004 · Cited by 1,692 · see citing works
Mitsiopoulos, N., Baumgartner, R. N., Heymsfield, S. B., Lyons, W., Gallagher, D., & Ross, R. (1998) · Journal of Applied Physiology · doi:10.1152/jappl.1998.85.1.115 · Cited by 1,522 · see citing works
Muscle Wasting Is Associated With Mortality in Patients With Cirrhosis
Montaño‐Loza, A. J., Meza–Junco, J., Prado, C. M. M., Lieffers, J. R. L., Baracos, V. E., Bain, V. G., & Sawyer, M. B. (2011) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2011.08.028 · Cited by 814 · see citing works
Sarcopenia and Mortality after Liver Transplantation
Englesbe, M. J., Patel, S. P., He, K., Lynch, R., Schaubel, D. E., Harbaugh, C. M., Holcombe, S. A., Wang, S. C., Segev, D. L., & Sonnenday, C. J. (2010) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.03.039 · Cited by 765 · see citing works
Sarcopenia from mechanism to diagnosis and treatment in liver disease
Dasarathy, S., & Merli, M. (2016) · Journal of Hepatology · doi:10.1016/j.jhep.2016.07.040 · Cited by 608 · see citing works
Self-citationTandon, P., Ney, M., Irwin, I., Ma, M. M., Gramlich, L. M., Bain, V. G., Esfandiari, N., Baracos, V. E., Montaño‐Loza, A. J., & Myers, R. P. (2012) · Liver Transplantation · doi:10.1002/lt.23495 · Cited by 580 · see citing works
Montano-Loza, A. J., Angulo, P., Meza-Junco, J., Prado, C. M. M., Sawyer, M. B., Beaumont, C., Esfandiari, N., Ma, M., & Baracos, V. E. (2016) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12039 · Cited by 512 · see citing works
Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography
Durand, F., Buyse, S., Francoz, C., Laouenan, C., Bruno, O., Belghiti, J., Moreau, R., Vilgrain, V., & Valla, D. C. (2014) · Journal of Hepatology · doi:10.1016/j.jhep.2014.02.026 · Cited by 385 · see citing works
Disparities in Liver Transplantation Before and After Introduction of the MELD Score
Moylan, C. A. (2008) · JAMA · doi:10.1001/jama.2008.720 · Cited by 363 · see citing works
van Vugt, J. L. A., Levolger, S., de Bruin, R. W. F., van Rosmalen, J., Metselaar, H. J., & IJzermans, J. N. M. (2016) · American Journal of Transplantation · doi:10.1111/ajt.13732 · Cited by 361 · see citing works
Montaño‐Loza, A. J., Duarte‐Rojo, A., Meza–Junco, J., Baracos, V. E., Sawyer, M. B., Pang, J. X. Q., Beaumont, C., Esfandiari, N., & Myers, R. P. (2015) · Clinical and Translational Gastroenterology · doi:10.1038/ctg.2015.31 · Cited by 357 · see citing works
Ethnicity‐related skeletal muscle differences across the lifespan
Silva, A. M., Shen, W., Heo, M., Gallagher, D., Wang, Z., Sardinha, L. B., & Heymsfield, S. B. (2009) · American Journal of Human Biology · doi:10.1002/ajhb.20956 · Cited by 312 · see citing works
Montaño‐Loza, A. J., Meza–Junco, J., Baracos, V. E., Prado, C. M. M., Ma, M. M., Meeberg, G., Beaumont, C., Tandon, P., Esfandiari, N., Sawyer, M. B., et al. (2014) · Liver Transplantation · doi:10.1002/lt.23863 · Cited by 301 · see citing works
Sarcopenia is a prognostic factor in living donor liver transplantation
Masuda, T., Shirabe, K., Ikegami, T., Harimoto, N., Yoshizumi, T., Soejima, Y., Uchiyama, H., Ikeda, T., Baba, H., & Maehara, Y. (2013) · Liver Transplantation · doi:10.1002/lt.23811 · Cited by 292 · see citing works
Kalafateli, M., Mantzoukis, K., Yau, Y. C., Mohammad, A. O., Arora, S., Rodrigues, S. G., de Vos, M., Papadimitriou, K., Thorburn, D., O’Beirne, J. P., et al. (2016) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12095 · Cited by 291 · see citing works
Tyrovolas, S., Koyanagi, A., Olaya, B., Ayuso‐Mateos, J. L., Miret, M., Chatterji, S., Tobiasz‐Adamczyk, B., Koskinen, S. V. P., Leonardi, M., & Haro, J. M. (2015) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.12076 · Cited by 287 · see citing works
Krell, R. W., Kaul, D. R., Martin, A. R., Englesbe, M. J., Sonnenday, C. J., Cai, S., & Malani, P. (2013) · Liver Transplantation · doi:10.1002/lt.23752 · Cited by 260 · see citing works
Meza–Junco, J., Montaño‐Loza, A. J., Baracos, V. E., Prado, C. M. M., Bain, V. G., Beaumont, C., Esfandiari, N., Lieffers, J. R. L., & Sawyer, M. B. (2013) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0b013e318293a825 · Cited by 248 · see citing works
Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation
Hamaguchi, Y., Kaido, T., Okumura, S., Fujimoto, Y., Ogawa, K., Mori, A., Hammad, A., Tamai, Y., Inagaki, N., & Uemoto, S. (2014) · Liver Transplantation · doi:10.1002/lt.23970 · Cited by 242 · see citing works
Montaño‐Loza, A. J. (2014) · Liver Transplantation · doi:10.1002/lt.23978 · Cited by 239 · see citing works
Muscle mass predicts outcomes following liver transplantation
DiMartini, A. F., Cruz, R. J., Dew, M. A., Myaskovsky, L., Goodpaster, B., Fox, K. R., Kim, K. H., & Fontes, P. (2013) · Liver Transplantation · doi:10.1002/lt.23724 · Cited by 238 · see citing works
Post‐liver transplantation sarcopenia in cirrhosis: A prospective evaluation
Tsien, C. D., Garber, A., Narayanan, A. S., Shah, S. N., Barnes, D. S., Eghtesad, B., Fung, J. J., McCullough, A. J., & Dasarathy, S. (2014) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.12524 · Cited by 181 · see citing works
Self-citationNIH ImageJ and Slice‐O‐Matic Computed Tomography Imaging Software to Quantify Soft Tissue
Irving, B. A., Weltman, J. Y., Brock, D. W., Davis, C. K., Gaesser, G. A., & WELTMAN, A. L. (2007) · Obesity · doi:10.1038/oby.2007.573 · Cited by 157 · see citing works
Lai, J. C., Terrault, N. A., Vittinghoff, E., & Biggins, S. W. (2010) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2010.03326.x · Cited by 130 · see citing works
Self-citationYadav, A. D., Chang, Y., Carpenter, S., Silva, A. C., Rakela, J. L., Aqel, B. A., Byrne, T., Douglas, D. D., Vargas, H. E., & Carey, E. J. (2014) · Clinical Transplantation · doi:10.1111/ctr.12493 · Cited by 130 · see citing works
Self-citationDevelopment of imaging methods to assess adiposity and metabolism
Heymsfield, S. B. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.242 · Cited by 61 · see citing works
Toshima, T., Shirabe, K., Kurihara, T., Itoh, S., Harimoto, N., Ikegami, T., Yoshizumi, T., Kawanaka, H., Ikeda, T., & Maehara, Y. (2015) · Hepatology Research · doi:10.1111/hepr.12484 · Cited by 48 · see citing works
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EASL Clinical Practice Guidelines on nutrition in chronic liver disease
Merli, M., Berzigotti, A., Zelber-Sagi, S., Dasarathy, S., Montagnese, S., Genton, L., Plauth, M., & Parés, A. (2019) · Journal of Hepatology · doi:10.1016/j.jhep.2018.06.024 · Cited by 1,130 · see citing works
Self-citationLai, J. C., Tandon, P., Bernal, W., Tapper, E. B., Ekong, U., Dasarathy, S., & Carey, E. J. (2021) · Hepatology · doi:10.1002/hep.32049 · Cited by 742 · see citing works
Self-citationESPEN guideline on clinical nutrition in liver disease
Plauth, M., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Bischoff, S. C. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.12.022 · Cited by 674 · see citing works
Self-citationDuarte‐Rojo, A., Ruiz‐Margáin, A., Montaño‐Loza, A. J., Macías‐Rodríguez, R. U., Ferrando, A., & Kim, W. R. (2018) · Liver Transplantation · doi:10.1002/lt.24958 · Cited by 221 · see citing works
van Vugt, J. L. A., Alferink, L. J. M., Buettner, S., Gaspersz, M. P., Bot, D., Darwish Murad, S., Feshtali, S., van Ooijen, P. M. A., Polak, W. G., Porte, R. J., et al. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2017.11.030 · Cited by 208 · see citing works
Nachit, M., Kwanten, W. J., Thissen, J.-P., Op De Beeck, B., Van Gaal, L., Vonghia, L., Verrijken, A., Driessen, A., Horsmans, Y., Francque, S., et al. (2021) · Journal of Hepatology · doi:10.1016/j.jhep.2021.02.037 · Cited by 114 · see citing works
Bone diseases in patients with chronic liver disease
Jeong, H., & Kim, D. (2019) · International Journal of Molecular Sciences · doi:10.3390/ijms20174270 · Cited by 113 · see citing works
Price, K. L., & Earthman, C. P. (2019) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0360-2 · Cited by 100 · see citing works
Association between low testosterone levels and sarcopenia in cirrhosis: A cross-sectional study
Moctezuma-Velázquez, C., Low, G., Mourtzakis, M., Ma, M., Burak, K. W., Tandon, P., & Montano-Loza, A. J. (2018) · Annals of Hepatology · doi:10.5604/01.3001.0012.0930 · Cited by 70 · see citing works
Self-citationSarcopenic obesity in fatty liver
Merli, M., Lattanzi, B., & Aprile, F. (2019) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000558 · Cited by 48 · see citing works
Alexopoulos, T., Vasilieva, L., Kontogianni, M. D., Tenta, R., Georgiou, A., Stroumpouli, E., Mani, I., & Alexopoulou, A. (2021) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00184.2021 · Cited by 40 · see citing works
Meena, B. L., Taneja, S., Tandon, P., Sahni, N., Soundararajan, R., Gorsi, U., De, A., Verma, N., Premkumar, M., Duseja, A., et al. (2023) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.16035 · Cited by 36 · see citing works
Osteosarcopenia in NAFLD/MAFLD: an underappreciated clinical problem in chronic liver disease
Musio, A., Perazza, F., Leoni, L., Stefanini, B., Dajti, E., Menozzi, R., Petroni, M. L., Colecchia, A., & Ravaioli, F. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24087517 · Cited by 26 · see citing works
Systematic review and meta-analysis of lean mass and mortality: Rationale and study description
Cheung, C.-L., Lee, G. K.-Y., Au, P. C.-M., Li, G. H.-Y., Chan, M., Li, H.-L., Cheung, B. M.-Y., Wong, I. C.-K., Lee, V. H.-F., Mok, J., et al. (2021) · Osteoporosis and Sarcopenia · doi:10.1016/j.afos.2021.01.001 · Cited by 18 · see citing works
- Authors
- Carey, E. J., Lai, J. C., Wang, C. W., Dasarathy, S., Lobach, I., Montano‐Loza, A. J., Dunn, M. A., & for the Fitness, L. E.
- Affiliations
- Mayo Clinic in Arizona (US)
- University of California, San Francisco (US)
- Cleveland Clinic (US)
- Division of Gastroenterology,University of Alberta,Edmonton,Alberta,Canada
- University of Pittsburgh (US)
- Corresponding author
- Carey, Elizabeth J.
- ORCID
- Venue
- Liver Transplantation
- Published
- 2017-04-24
- Volume
- 23
- Issue
- 5
- Pages
- 625-633
- ISSN
- 1527-6465 (ISSN-L)
- 1527-6473
- PMC
- PMC5762612
- OpenAlex
- W2593939817
- Cited by
- 498
- References
- 30
- Citations by year
- 2026: 39 · 2025: 54 · 2024: 58 · 2023: 64 · 2022: 62 · 2021: 67 · 2020: 47 · 2019: 60 · 2018: 33 · 2017: 12
- FWCI
- 30.50
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Liver Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (K23AG048337)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- sarcopenia, end-stage liver disease, waitlist mortality, skeletal muscle index, computed tomography, transplant waiting list
- MeSH terms
- Female, Humans, Male, Middle Aged, Retrospective Studies, Sex Factors, United States, Sarcopenia, End Stage Liver Disease
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