Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis

Abstract

Background/aims: Sarcopenia negatively affects the prognosis of cirrhotic patients, but clinical implications of changes in muscle mass remain unclear. We aimed to elucidate its role in the prognosis of outpatients with cirrhosis.

Methods: Patients with cirrhosis who underwent annual abdominal computed tomography (CT) for hepatocellular carcinoma surveillance were included in the prospective cohort. The L3 skeletal muscle index (SMI) was adopted as a proxy for the amount of skeletal muscle, and the rate of SMI change between inclusion and after 1 year (ΔSMI/yr%) was calculated.

Results: In total, 595 patients underwent a second CT after 1 year. Among them, 109 and 64 patients had sarcopenia and Child-Pugh class B/C decompensation at inclusion, which changed to 103 and 45 at the 1-year follow-up, respectively. During a median follow-up of 30.1 months after 1 year, 86 patients had at least one cirrhosis complication, and 18 died or received liver transplantation. In the development of cirrhosis complications, ΔSMI/yr% was independently associated, even after adjusting for the Child-Pugh and model for end stage liver disease (MELD)-Na scores. In addition, ΔSMI/yr% showed a good predictive performance for the development of cirrhosis complications within 6 months after 1-year follow-up in all subgroups, with a cut-off of -2.62 (sensitivity, 83.9%; specificity, 74.5%) in the overall population. SMI at 1-year and Child-Pugh score were independent factors associated with survival. In addition, changes in sarcopenia status significantly stratified survival.

Conclusion: ΔSMI/yr% was a good predictor of the development of cirrhosis complications in outpatients with cirrhosis, independent of Child-Pugh and MELD scores.

Keywords: Liver cirrhosis; Prognosis; Sarcopenia; Survival.

Figure 1.

Flow diagram of patient inclusion. HCC, hepatocellular carcinoma; CT, computed tomography.

Figure 2.

Kaplan-Meier plots for LT-free survival after 1-year CT. (A) LT-free survival was not significantly different between two groups with non-sarcopenia and sarcopenia at 1 year (P=0.48). The LT-free survival was significantly stratified by (B) four groups (NN, SN, NS, and SS; overall P=0.04) and (C) eight groups (NN_A, NN_BC, SN_A, SN_BC, NS_A, NS_BC, SS_A, and SS_BC; overall P<0.001). There was no patient belonging to SN_BC. (D) The survival was well-stratified by G1–4 and Child-Pugh class (P<0.001), but not by ΔSMI/yr%. LT, liver transplantation; NN, nonsarcopenia to non-sarcopenia; SN, sarcopenia to non-sarcopenia; NS, non-sarcopenia to sarcopenia; SS, sarcopenia to sarcopenia; NN_A, NN with Child-Pugh class A; NN_BC, NN with Child-Pugh class B/C; SN_A, SN with Child-Pugh class A; NS_A, NS with Child-Pugh class A; NS_BC, NS with Child-Pugh class B/C; SS_A, SS with Child-Pugh class A; SS_BC, SS with Child-Pugh class B/C; G1, Child-Pugh class A and ΔSMI/yr% ≥-3.66; G2, Child-Pugh class A and ΔSMI/yr% <-3.66; G3, Child-Pugh class B/C and ΔSMI/yr% ≥-2.62; G4, Child-Pugh class B/C and ΔSMI/yr% <-2.62; CT, computed tomography; ΔSMI/yr%, % change in skeletal muscle index after 1 year.

Figure 3.

Kaplan-Meier plots for the development of cirrhosis complication after 1-year CT. The development of cirrhosis complication was not well-stratified by (A) the sarcopenia status and (B) sarcopenia status change (P=0.30 and 0.73, respectively). However, based on (C) the four groups (G1–4) classified by Child-Pugh class and ΔSMI/yr%, it was well distinguished (P<0.001). LC, liver cirrhosis; NN, non- sarcopenia to non-sarcopenia; SN, sarcopenia to non-sarcopenia; NS, non-sarcopenia to sarcopenia; SS, sarcopenia to sarcopenia; G1, Child-Pugh class A and ΔSMI/yr% ≥-3.66; G2, Child-Pugh class A and ΔSMI/yr% <-3.66; G3, Child-Pugh class B/C and ΔSMI/yr% ≥-2.62; G4, Child-Pugh class B/C and ΔSMI/yr% <-2.62; CT, computed tomography; ΔSMI/yr%, % change in skeletal muscle index after 1 year.

Figure 4.

Receiver operating characteristic curve of ΔSMI/yr% for development of cirrhosis complication within 6 months after 1-year CT. The AUCs of ΔSMI/yr% were (A) 0.817 in all, (B) 0.855 in patients with Child-Pugh class A, and (C) 0.754 in those with Child-Pugh classes B/C. ΔSMI/ yr%, % change in skeletal muscle index after 1 year; CT, computed tomography; AUC, area under curve.