CoChat
Sign Up
Cited by 46Liver Disease and TransplantationNutrition and Health in AgingLiver Disease Diagnosis and Treatment

Prognostic impact of sarcopenia in cirrhotic patients stratified by different severity of portal hypertension

Open access
Paternostro, Rafael, Bardach, Constanze, Hofer, Benedikt S., Scheiner, Bernhard, Schwabl, Philipp, Asenbaum, Ulrika, Ba‐Ssalamah, Ahmed, Scharitzer, Martina +7 more·2021·Liver International
DOI 10.1111/liv.14758PMC PMC8048669
Open this paper in CoChat — free accountOpen PDF

Abstract

Background and Aims: Portal hypertension (PH) and sarcopenia are common in patients with advanced chronic liver disease (ACLD). However, the interaction between PH and sarcopenia and their specific and independent impact on prognosis and mortality has yet to be systematically investigated in patients with ACLD. Methods: Consecutive patients with ACLD and hepatic venous pressure gradient (HVPG) ≥10 mm Hg with available CT/MRI imaging were included. Sarcopenia was defined by transversal psoas muscle thickness (TPMT) at <12 mm/m in men and <8 mm/m in women at the level of the third lumbar vertebrae. Hepatic decompensation and mortality was recorded during follow‐up. Results: Among 203 patients (68% male, age: 55 ± 11, model for end‐stage liver disease [MELD]: 12 [9‐15]), sarcopenia was observed in 77 (37.9%) and HVPG was ≥20 mm Hg in 98 (48.3%). There was no correlation between TPMT and HVPG (r = .031, P = .66), median HVPG was not different between patients with vs without sarcopenia (P = .211). Sarcopenia was significantly associated with first/further decompensation both in compensated (SHR: 3.05, P = .041) and in decompensated patients (SHR: 1.86, P = .021). Furthermore, sarcopenia (SARC) was a significant predictor of mortality irrespective of HVPG (HVPG < 20‐SARC: SHR: 2.25, P = .021; HVPG ≥ 20‐SARC: SHR: 3.33, P = .001). On multivariate analysis adjusted for age, HVPG and MELD, sarcopenia was an independent risk factor for mortality (aHR: 1.99, 95% confidence interval: 1.2‐3.3, P = .007). Conclusion: Sarcopenia has a major impact on clinical outcomes both in compensated and in decompensated ACLD patients. The presence of sarcopenia doubled the risk for mortality independently from the severity of PH.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/liv.14758

Cites

6 of 6 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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 [111]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 35

  1. [1]Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther. 2016; 43: 765‐ 777. 26847265
  2. [3]Duarte‐Rojo A, Ruiz‐Margain A, Montano‐Loza AJ, Macias‐Rodriguez RU, Ferrando A, Kim WR. Exercise and physical activity for patients with end‐stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list. Liver Transplant. 2018; 24(1): 122‐ 139. 29024353
  3. [4]Montano‐Loza AJ, Meza‐Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012; 10(2): 166‐ 173, 73.e1. 21893129
  4. [5]Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transplant. 2012; 18(10): 1209‐ 1216. 22740290
  5. [6]Durand F, Buyse S, Francoz C, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography. J Hepatol. 2014; 60(6): 1151‐ 1157. 24607622
  6. [7]EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70(1): 172‐ 193. 30144956 PMC6657019
  7. [8]Wiesner R, Edwards E, Freeman R, et al. Model for end‐stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003; 124(1): 91‐ 96. 12512033
  8. [9]Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver‐transplant waiting list. N Engl J Med. 2008; 359(10): 1018‐ 1026. 18768945 PMC4374557
  9. [10]Montano‐Loza AJ, Duarte‐Rojo A, Meza‐Junco J, et al. Inclusion of sarcopenia within MELD (MELD‐sarcopenia) and the prediction of mortality in patients with cirrhosis. Clin Translat Gastroenterol. 2015; 6: e102. PMC4816259 26181291
  10. [12]Kim G, Kang SH, Kim MY, Baik SK. Prognostic value of sarcopenia in patients with liver cirrhosis: a systematic review and meta‐analysis. PLoS One. 2017; 12(10):e0186990. PMC5655454 29065187
  11. [13]Huguet A, Latournerie M, Debry PH, et al. The psoas muscle transversal diameter predicts mortality in patients with cirrhosis on a waiting list for liver transplantation: a retrospective cohort study. Nutrition. 2018; 51–52: 73‐ 79. 29605767
  12. [14]Praktiknjo M, Book M, Luetkens J, et al. Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis. Hepatology. 2018; 67(3): 1014‐ 1026. 29059469
  13. [15]Paternostro R, Lampichler K, Bardach C, et al. The value of different CT‐based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. Liver Int. 2019; 39(12): 2374‐ 2385. 31421002 PMC6899596
  14. [16]Zenith L, Meena N, Ramadi A, et al. Eight weeks of exercise training increases aerobic capacity and muscle mass and reduces fatigue in patients with cirrhosis. Clin Gastroenterol Hepatol. 2014; 12(11): 1920‐6.e2. 24768811
  15. [17]Kruger C, McNeely ML, Bailey RJ, et al. Home exercise training improves exercise capacity in cirrhosis patients: role of exercise adherence. Sci Rep. 2018; 8(1): 99. 29311671 PMC5758716
  16. [18]Hiraoka A, Michitaka K, Kiguchi D, et al. Efficacy of branched‐chain amino acid supplementation and walking exercise for preventing sarcopenia in patients with liver cirrhosis. Eur J Gastro Hepatol. 2017; 29(12): 1416‐ 1423. 29016470
  17. [19]Tsien C, Shah SN, McCullough AJ, Dasarathy S. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastro Hepatol. 2013; 25(1): 85‐ 93. 23011041
  18. [20]D'Amico G, Morabito A, D'Amico M, et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018; 68(3): 563‐ 576. 29111320
  19. [21]de Franchis R. Expanding consensus in portal hypertension: report of the Baveno VI consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015; 63(3): 743‐ 752. 26047908
  20. [22]Reiberger T, Ulbrich G, Ferlitsch A, et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non‐response to propranolol. Gut. 2013; 62(11): 1634‐ 1641. 23250049
  21. [23]Garcia‐Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2017; 65(1): 310‐ 335. 27786365
  22. [24]Groszmann RJ, Garcia‐Tsao G, Bosch J, et al. Beta‐blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005; 353(21): 2254‐ 2261. 16306522
  23. [25]Reiberger T, Puspok A, Schoder M, et al. Austrian consensus guidelines on the management and treatment of portal hypertension (Billroth III). Wien Klin Wochenschr. 2017; 129(Suppl 3): 135‐ 158. 29063233 PMC5674135
  24. [26]Abraldes JG, Villanueva C, Banares R, et al. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol. 2008; 48(2): 229‐ 236. 18093686
  25. [27]Moitinho E, Escorsell A, Bandi JC, et al. Prognostic value of early measurements of portal pressure in acute variceal bleeding. Gastroenterology. 1999; 117(3): 626‐ 631. 10464138
  26. [28]Kang SH, Jeong WK, Baik SK, Cha SH, Kim MY. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle. 2018; 9(5): 860‐ 870. 30371017 PMC6204582
  27. [29]Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population‐based study. Lancet Oncol. 2008; 9(7): 629‐ 635. 18539529
  28. [30]Ferlitsch A, Bota S, Paternostro R, et al. Evaluation of a new balloon occlusion catheter specifically designed for measurement of hepatic venous pressure gradient. Liver Int 2015 35(9): 2115‐ 2120. 25585656
  29. [31]Paternostro R, Reiberger T, Mandorfer M, et al. Plasma renin concentration represents an independent risk factor for mortality and is associated with liver dysfunction in patients with cirrhosis. J Gastroenterol Hepatol. 2017; 32(1): 184‐ 190. 27164413
  30. [34]Sinclair M, Grossmann M, Angus PW, et al. Low testosterone as a better predictor of mortality than sarcopenia in men with advanced liver disease. J Gastroenterol Hepatol. 2016; 31(3): 661‐ 667. 26414812
  31. [35]Lucidi C, Lattanzi B, Di Gregorio V, et al. A low muscle mass increases mortality in compensated cirrhotic patients with sepsis. Liver Int. 2018; 38(5): 851‐ 857. 29323441
  32. [36]Kim TY, Kim MY, Sohn JH, et al. Sarcopenia as a useful predictor for long‐term mortality in cirrhotic patients with ascites. J Korean Med Sci. 2014; 29(9): 1253‐ 1259. 25246744 PMC4168179
  33. [39]Paternostro R, Heinisch BB, Reiberger T, et al. Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension. Liver Int. 2018; 38(8): 1427‐ 1436. 29368385 PMC6766949
  34. [40]Paternostro R, Heinisch BB, Reiberger T, et al. Dysbalanced sex hormone status is an independent predictor of decompensation and mortality in patients with liver cirrhosis. Hepatol Res 2018; 49(2): 201‐ 211. 30248213 PMC7379971
  35. [41]Sinclair M, Grossmann M, Gow PJ, Angus PW. Testosterone in men with advanced liver disease: abnormalities and implications. J Gastroenterol Hepatol. 2015; 30(2): 244‐ 251. 25087838

Cited by

Sorted by citations

Authors
Paternostro, R., Bardach, C., Hofer, B. S., Scheiner, B., Schwabl, P., Asenbaum, U., Ba‐Ssalamah, A., Scharitzer, M., Bucscis, T., Simbrunner, B., Bauer, D., Trauner, M., Mandorfer, M., Reiberger, T., & Lampichler, K.
Affiliations
  • Medical University of Vienna (AT)
  • Vienna Hepatic Hemodynamic Lab Medical University of Vienna Vienna Austria
Corresponding author
Reiberger, Thomas
ORCID
Venue
Liver International
Publisher
Wiley
Published
2020-12-22
Volume
41
Issue
4
Pages
799-809
ISSN
  • 0106-9543 (ISSN-L)
  • 1478-3223
  • 1478-3231
DOI
10.1111/liv.14758
PMC
PMC8048669
OpenAlex
W3110981431
Cited by
46
References
6
Citations by year
2026: 8 · 2025: 4 · 2024: 8 · 2023: 12 · 2022: 10 · 2021: 4
FWCI
3.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Liver International (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
Keywords
sarcopenia, portal hypertension, advanced chronic liver disease, liver cirrhosis, hepatic venous pressure gradient, hepatic decompensation, mortality, prognostic factors, MELD score
MeSH terms
Adult, Aged, Female, Humans, Hypertension, Portal, Liver Cirrhosis, Male, Middle Aged, Prognosis, Severity of Illness Index, Portal Pressure, Sarcopenia, End Stage Liver Disease

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review