Predictive performance of distinct skeletal muscle index cut-offs-defined sarcopenia for long-term mortality in decompensated cirrhosis: A prospective observational study.

PURPOSE: Although the clinical implication of sarcopenia has been verified in the context of cirrhosis, there is limited data concerning cut-offs of CT-measured skeletal muscle index (SMI) across different ethnicities. We aimed to compare the predictive performance of distinct SMI values-defined sarcopenia for prognosis in cirrhosis.

METHODS

Totally, 478 inpatients due to cirrhosis-associated acute insults were prospectively enrolled. A range of cut-offs concerning SMI (Tianjin, northernChina, southernChina, Japan and Turkey criteria) were testified to determine 2-year all-cause mortality according to the Kaplan-Meier survival curve and multivariate Cox regression model.

RESULTS

Sarcopenia was diagnosed in 24.3 %, 6.3 %, 21.1 %, 29.1 % and 6.5 %, respectively, according to Tianjin, northernChina, southernChina, Japan and Turkey criteria. Survival analysis showed marked differences between patients with and without sarcopenia defined by all aforesaid criteria (log-rank test: P < 0.05). Univariate Cox regression indicated that age, Child-Turcotte-Pugh (CTP) class, Model for End-stage Liver Disease-Sodium (MELD-Na), creatinine, bilirubin, white blood cell count, prothrombin time-international normalized ratio, sodium, albumin, ascites, hepatic encephalopathy, infection and sarcopenia were significantly associated with mortality. Further multivariate model fully adjusting age, BMI and MELD-Na/CTP class revealed that all criteria-defined sarcopenia was independently associated with mortality, except for the Turkey criteria.

CONCLUSIONS

Our findings provide supporting evidence to develop continent-based SMI cut-offs in hopes of identifying sarcopenic patients with cirrhosis, taking its impact on mortality and morbidity into consideration.