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Cited by 71Nutrition and Health in AgingLiver Disease and TransplantationBody Composition Measurement Techniques

The value of different CT‐based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis

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Paternostro, Rafael, Lampichler, Katharina, Bardach, Constanze, Asenbaum, Ulrika, Landler, Clara, Bauer, David, Mandorfer, Mattias, Schwarzer, Remy +3 more·2019·Liver International
DOI 10.1111/liv.14217PMC PMC6899596
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Abstract

Background & Aims: Low muscle mass impacts on morbidity and mortality in cirrhosis. The skeletal‐muscle index (SMI) is a well‐validated tool to diagnose muscle wasting, but requires specialized radiologic software and expertise. Thus, we compared different Computed tomography (CT)‐based evaluation methods for muscle wasting and their prognostic value in cirrhosis. Methods: Consecutive cirrhotic patients included in a prospective registry undergoing abdominal CT scans were analysed. 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 cm 2/m 2; females: <38.5 cm 2/m 2). Results: One hundred and nine patients (71.6% male) of age 57 ± 11 years, MELD 16 (8‐26) and alcoholic liver disease (63.3%) as the main aetiology were included. According to established SMI cut‐offs, low muscle mass was present in 69 patients (63.3%) who also presented with higher MELD (17 vs 14 points; P = .025). The following optimal sex‐specific cut‐offs (men/women) for diagnosing low muscle mass were determined: TPMT: <10.7/ <7.8 mm/m, TPV: <194.9/ <99.2 cm 3 and PSMI <26.3/ <20.8 cm 2/m 2. Thirty (27.5%) patients died during a follow‐up of 15 (0.3‐45.7) months. Univariate competing risks analyses showed a significant risk for mortality according to SMI (aSHR:2.52, 95% CI: 1.03‐6.21, P = .043), TPMT (aSHR: 3.87, 95% CI: 1.4‐8.09, P = .007) and PSMI (aSHR: 2.7, 95% CI: 1.17‐6.23, P = .02), but not TPV (P = .18) derived low muscle mass cut‐offs. In multivariate analysis only TPMT (aSHR: 2.82, 95% CI: 1.20‐6.67, P = .018) was associated with mortality, SMI (aSHR: 1.93, 95% CI: 0.72‐5.16, P = .19) and PSMI (aSHR: 1.93, 95% CI: 0.79‐4.75, P = .15) were not. Conclusion: Low muscle mass was highly prevalent in our cohort of patients with cirrhosis. Gender‐specific TPMT, SMI and PSMI cut‐offs for low muscle mass can help identify patients with an increased risk for mortality. Importantly, only TPMT emerged as an independent risk factor for mortality in patients with cirrhosis.

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  • Malnutrition, frailty, and especially sarcopenia have become increasingly important in patients with advanced chronic liver disease.

    “Finally, malnutrition [105], frailty [106, 107] and especially sarcopenia [108, 109, 110, 111] have become increasingly important in patients with advanced chronic liver disease and should be evaluated and treated in each patient.”

    From Current treatment of non‐alcoholic fatty liver disease (2022) · cites this paper as [110]

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Authors
Paternostro, R., Lampichler, K., Bardach, C., Asenbaum, U., Landler, C., Bauer, D., Mandorfer, M., Schwarzer, R., Trauner, M., Reiberger, T., & Ferlitsch, A.
Affiliations
  • Medical University of Vienna (AT)
  • Vienna Hepatic Hemodynamic Lab Medical University of Vienna Vienna Austria
  • Hospital of the Brothers of St. John of God (AT)
Corresponding author
Ferlitsch, Arnulf
ORCID
Venue
Liver International
Publisher
Wiley
Published
2019-09-11
Volume
39
Issue
12
Pages
2374-2385
ISSN
  • 0106-9543 (ISSN-L)
  • 1478-3223
  • 1478-3231
DOI
10.1111/liv.14217
PMC
PMC6899596
OpenAlex
W2967446376
Cited by
71
References
7
Citations by year
2026: 4 · 2025: 10 · 2024: 10 · 2023: 14 · 2022: 9 · 2021: 12 · 2020: 10 · 2018: 1
FWCI
5.32
Type
journal article
Language
en
Open access
Licence
Locations
  • Liver International (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
liver cirrhosis, sarcopenia, skeletal muscle index, muscle atrophy, mortality prediction, prognostic factors, alcoholic liver disease, MELD score, competing risk analysis, CT-based muscle assessment, liver disease complications, nutritional assessment
MeSH terms
Aged, Austria, Female, Humans, Liver Cirrhosis, Alcoholic, Male, Middle Aged, Tomography, X-Ray Computed, Psoas Muscles, Sarcopenia, Paraspinal Muscles

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