Alcohol-associated liver disease increases the risk of muscle loss and mortality in patients with cirrhosis

Abstract

Background: Rapid skeletal muscle loss adversely affects the clinical outcomes of liver cirrhosis. However, the relationships between the annual changes in skeletal muscle area (ΔSMA/year) and the etiology of cirrhosis, factors associated with muscle loss, and risk of mortality remains unclear.

Methods: A total of 384 patients who underwent multiple computed tomography (CT) scans between March 2004 and June 2021 were enrolled in this study (median age, 67 years; 64% men; median model for end-stage liver disease score, 9). Body composition and ΔSMA/year were estimated using a 3D image analysis system and data from at least two distinct CT scans. Differences in ΔSMA/year among different etiologies of cirrhosis, factors associated with rapid muscle loss (defined as ΔSMA/year ≤ - 3.1%), and the association between ΔSMA/year and mortality were examined.

Results: Patients with alcohol-associated liver disease (ALD) cirrhosis experienced more rapid muscle loss (ΔSMA/year, - 5.7%) than those with hepatitis B (ΔSMA/year, - 2.8%) and hepatitis C cirrhosis (ΔSMA/year, - 3.1%). ALD cirrhosis was independently associated with ΔSMA/year ≤ - 3.1% after adjusting for age, sex, and liver functional reserve. Over a median follow-up period of 3.8 years, ALD cirrhosis, ΔSMA/year ≤ - 3.1%, and low subcutaneous adipose tissue level were found to be significantly associated with reduced survival. ALD cirrhosis (hazard ratio [HR], 2.43; 95% confidence interval [CI] 1.12-5.28) and ΔSMA/year ≤ - 3.1% (HR, 3.68; 95% CI 2.46-5.52) were also predictive of mortality.

Conclusions: These results suggest that ALD cirrhosis increases the risk of rapid muscle loss and mortality in affected patients.

Keywords: Alcohol-associated liver disease; Liver cirrhosis; Mortality; Muscle loss rate; Sarcopenia.

Fig. 1

Changes in skeletal muscle area in patients with liver cirrhosis a comparison of ΔSMA/year in patients with ALD, HBV, and HCV cirrhosis. b Prevalence of ΔSMA/year ≤  − 3.1% for each etiology. c Comparison of ΔSMA/year between sexes. d Correlation coefficients between ΔSMA/year and MELD score. Data were analyzed using the Mann–Whitney U test, Kruskal–Wallis test, Steel–Dwass test, Pearson’s Chi-square test, and Spearman’s rank correlation coefficient. ALD alcohol-associated liver disease; HBV hepatitis B virus; HCV hepatitis C virus; MELD model for end-stage liver disease; ΔSMA change in skeletal muscle area

Fig. 2

Survival curves for patients with a ALD, HBV, and HCV cirrhosis, b ΔSMA/year) ≤  − 3.1% and >  − 3.1%, and c high (> 35.8 cm²/m²) and low SATI (≤ 35.8 cm²/m²). Survival over time was estimated using the Kaplan–Meier method and compared using the log-rank test. ALD alcohol-associated liver disease; HBV hepatitis B virus; HCV hepatitis C virus; ΔSMA change in skeletal muscle area; SATI subcutaneous adipose tissue index