Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent

Abstract

Background: Sarcopenia is the most frequent complication of cirrhosis. A transjugular intrahepatic portosystemic stent (TIPS) lowers portal pressure in cirrhosis and alters the body composition. Changes in the skeletal muscle area and adipose tissue volume were quantified by computed tomography (CT) before and after TIPS.

Materials and methods: Fifty-seven consecutive cirrhotics who had a CT scan before and after TIPS were studied. Simultaneous age-matched, sex-matched, Child's score-matched, and Model for End-Stage Liver Disease score-matched cirrhotics (n=32) who did not undergo TIPS comprised the disease control and 57 healthy individuals who had undergone CT abdomen comprised the healthy control population. Muscle area and fat volume were obtained at the mid-L4 vertebra level on the CT scans.

Results: Patients (mean age 55.5±8.1 years) were followed up for a mean of 13.5±11.9 months following TIPS. Total psoas and paraspinal muscle area increased significantly (P<0.0001) after TIPS (from 22.8±0.9 to 25.1±0.9 cm and 54.5±1.3 to 57.9±1.5 cm, respectively). After TIPS, muscle area increased in 41 patients but remained unchanged or decreased in 16 patients. Post-TIPS visceral fat volume decreased significantly (47.7±4.1 to 40.5±3.4 cm; P<0.001). Failure to reverse sarcopenia after TIPS was accompanied by higher (P=0.007) mortality (43.5%) compared with patients in whom the total muscle area increased (9.8%). On multivariate analysis, predictors of reversal of sarcopenia after TIPS included male sex and lower pre-TIPS muscle area. Cirrhotic patients who did not undergo TIPS showed no change in the mean muscle area over 13.1±1.3 months.

Conclusion: TIPS reverses sarcopenia in cirrhotic patients. Failure to improve muscle area after TIPS was accompanied by a higher mortality.