Impact of year-to-year changes in skeletal muscle mass on the prediction of long-term survival in patients with liver cirrhosis.

BACKGROUND

Sarcopenia is the progressive loss of muscle mass that worsens the clinical outcomes of cirrhosis. Here, we aimed to investigate the changes in skeletal muscle index (ΔSMI) over an intermediate period of time to comprehensively elucidate its prognostic value for long-term mortality in cirrhosis.

MATERIALS AND

METHODS

This ambispective cohort study included patients with cirrhosis who underwent abdominal computed tomography (CT) between January 2012 and December 2021. SMI was obtained from annual CT scans at the third lumbar vertebra. The effect of the first 3 y of the annual rate of change in SMI (∆SMI/yr%) was calculated and its prognosis at the next long-term follow-up was analyzed.

RESULTS

Overall, 384 patients who underwent at least two CT examinations during the first 3 y were enrolled. Here, 120 men (31.3%) and 44 women (11.5%) had sarcopenia at baseline. At an average follow-up of 71.52 mo, 257 (66.9%) patients were with liver transplantation (LT)-free. Sarcopenia defined status at 1 to 3 y tended to be a prognostic factor. Patients with a change in sarcopenia status from normal to sarcopenic had worse outcomes in terms of LT-free survival. Based on Cox and competing risk model analyses, ∆SMI/yr% was independently associated with poor survival. When separated by a cutoff of ∆SMI/yr% -2.08 derived from the receiver operating characteristic (ROC) analysis, ∆SMI/yr% < -2.08 was not associated with age, but it did significantly discriminate the patients with decompensation, bacterial infection, and severe liver dysfunction (P value < 0.05).

CONCLUSIONS

SMI/yr% performs as an effective index for predicting poor long-term outcomes in patients with cirrhosis, independent of age. Early short-term monitoring of SMI could guide clinical decision-making regarding nutritional interventions in cirrhosis.