Frontiers in nutrition · 2026
Prognostic impact of low muscle mass and visceral adiposity in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt: a retrospective cohort study.
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Wen Zhang, Yuan Jia, Li Yong, Liu Ying, Wang Xinyu, Tuo Shuyue, Shi Meijuan, Wang Jinhai, Dai Shejiao, Li Lu, Tantai Xinxing
Аннотация
OBJECTIVE: The prognostic value of low muscle mass and visceral adiposity (LMM-VA) in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt (TIPS) has not yet been investigated. We aimed to define LMM-VA using computed tomography-based skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR), and to examine its association with post-TIPS outcomes.
METHODS: This retrospective cohort study included adult patients with cirrhosis undergoing TIPS. LMM-VA was defined as the coexistence of low muscle mass (SMI < 44.7 cm2/m2 in males and < 32.5 cm2/m2 in females) and visceral adiposity (VSR ≥ 1.21 in males and ≥ 0.48 in females). Associations between LMM-VA and post-TIPS outcomes were evaluated using cumulative incidence curves and univariable and multivariable regression models.
RESULTS: A total of 228 patients with cirrhosis were included in the study, 54 (23.7%) of whom had LMM-VA. During a median follow-up of 29.2 months, patients with LMM-VA showed a significantly higher cumulative incidence of both all-cause mortality (p < 0.001) and liver-related mortality (p < 0.001). LMM-VA was significantly associated with post-TIPS all-cause mortality in both the univariable (hazard ratio [HR]: 3.62, 95% confidence interval [CI]: 1.65-7.91) and multivariable Cox regression analyses (HR: 3.21, 95% CI: 1.32-7.80). Subgroup, sensitivity, and stratified analyses further confirmed the robustness of this association. Additionally, LMM-VA demonstrated an independent prognostic value for liver-related mortality but not for either new-onset or further decompensation. The significant association between LMM-VA and all-cause mortality was lost when LMM-VA was defined by either a visceral adipose tissue area of ≥ 100 cm2 or body mass index of ≥ 25.0 kg/m2.
CONCLUSION: LMM-VA is significantly associated with increased post-TIPS mortality in patients with cirrhosis and may serve as a promising prognostic marker that requires further validation.
METHODS: This retrospective cohort study included adult patients with cirrhosis undergoing TIPS. LMM-VA was defined as the coexistence of low muscle mass (SMI < 44.7 cm2/m2 in males and < 32.5 cm2/m2 in females) and visceral adiposity (VSR ≥ 1.21 in males and ≥ 0.48 in females). Associations between LMM-VA and post-TIPS outcomes were evaluated using cumulative incidence curves and univariable and multivariable regression models.
RESULTS: A total of 228 patients with cirrhosis were included in the study, 54 (23.7%) of whom had LMM-VA. During a median follow-up of 29.2 months, patients with LMM-VA showed a significantly higher cumulative incidence of both all-cause mortality (p < 0.001) and liver-related mortality (p < 0.001). LMM-VA was significantly associated with post-TIPS all-cause mortality in both the univariable (hazard ratio [HR]: 3.62, 95% confidence interval [CI]: 1.65-7.91) and multivariable Cox regression analyses (HR: 3.21, 95% CI: 1.32-7.80). Subgroup, sensitivity, and stratified analyses further confirmed the robustness of this association. Additionally, LMM-VA demonstrated an independent prognostic value for liver-related mortality but not for either new-onset or further decompensation. The significant association between LMM-VA and all-cause mortality was lost when LMM-VA was defined by either a visceral adipose tissue area of ≥ 100 cm2 or body mass index of ≥ 25.0 kg/m2.
CONCLUSION: LMM-VA is significantly associated with increased post-TIPS mortality in patients with cirrhosis and may serve as a promising prognostic marker that requires further validation.