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. 2015 Jul 16;6(7):e102.
doi: 10.1038/ctg.2015.31.

Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis

Aldo J Montano-Loza  1 , Andres Duarte-Rojo  2 , Judith Meza-Junco  3 , Vickie E Baracos  3 , Michael B Sawyer  3 , Jack X Q Pang  4 , Crystal Beaumont  3 , Nina Esfandiari  3 , Robert P Myers  4
Affiliations

Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis

Aldo J Montano-Loza et al. Clin Transl Gastroenterol. .

Abstract

Objectives: Limitations of the Model for End-Stage Liver Disease (MELD) score include its failure to assess the nutritional and functional status of cirrhotic patients. Our objectives were to evaluate the impact of sarcopenia in cirrhosis and whether the inclusion of muscularity assessment within MELD could improve the prediction of mortality in patients with cirrhosis.

Methods: We included 669 cirrhotic patients who were consecutively evaluated for liver transplantation. Skeletal muscle index at the third lumbar vertebra (L3 SMI) was measured by computed tomography, and sarcopenia was defined using previously published gender and body mass index-specific cutoffs. Using Cox proportional hazards regression, a novel MELD-sarcopenia score was derived.

Results: Sarcopenia was present in 298 patients (45%); sarcopenic patients had shorter median survival than non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality. Overall, the c-statistics for 3-month mortality were 0.82 (95% CI 0.78-0.87) for MELD and 0.85 (95% CI 0.81-0.88) for MELD-sarcopenia (P=0.1). Corresponding figures for 1-year mortality were 0.73 (95% CI 0.69-0.77) and 0.77 (95% CI 0.73-0.80), respectively (P=0.03). The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.

Conclusions: Modification of MELD to include sarcopenia is associated with improved prediction of mortality in patients with cirrhosis, primarily in patients with low MELD scores. External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

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Figures

Figure 1
Figure 1
Flowchart of patients excluded/included for the muscularity assessment analyses in this cohort. CT, computed tomography; MELD, Model for End-Stage Liver Disease.
Figure 2
Figure 2
Comparison of two female patients with cirrhosis. Abdominal computed tomography images taken at third lumbar vertebra. Red color indicates skeletal muscle, green color indicates intermuscular adipose tissue, yellow color indicates visceral adipose tissue, and teal indicates subcutaneous adipose tissue. The patient at the left has severe sarcopenia (lumbar skeletal index, 35 cm2/m2) and the patient at the right is not sarcopenic (lumbar skeletal index, 54 cm2/m2).
Figure 3
Figure 3
Kaplan–Meier curves indicating the survival of patients with (—) and without (—) sarcopenia. The 3-month estimated probabilities of survival in patients with and without cirrhosis were 80% and 93%, respectively. Corresponding figures at 6 and 12 months were 71% and 90% and 53% and 83%, respectively (all P<0.00005 by log-rank tests).
See this image and copyright information in PMC

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