A multicenter study to define sarcopenia in patients with end‐stage liver disease

Liver Transplantation - Tập 23 Số 5 - Trang 625-633 - 2017
Elizabeth J. Carey1, Jennifer C. Lai2, Connie W. Wang3, Srinivasan Dasarathy4, Iryna Lobach5, Aldo J. Montaño‐Loza6, Michael A. Dunn7
1Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Phoenix, AZ
2Division of Gastroenterology and Hepatology,University of California,San Francisco, San Francisco,CA
3Division of Internal Medicine,University of California,San Francisco, San Francisco,CA
4Division of Gastroenterology and Hepatology, Cleveland Clinic,Cleveland,OH
5Division of Epidemiology and Biostatistics,University of California,San Francisco, San Francisco,CA
6Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
7Center for Liver Diseases, Liver Research Center, Thomas E. Starzl Transplantation Institute,University of Pittsburgh,Pittsburgh,PA

Tóm tắt

Sarcopenia is associated with increased wait‐list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end‐stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross‐sectional area (cm2) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait‐list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex‐specific potential cutoff values to define sarcopenia were determined with a grid search guided by log‐rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2/m2: 50.0 in men and 42.0 in women. At a median of 8.8 months follow‐up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2/m2; P < 0.001), and SMI was associated with wait‐list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2/m2 for men and < 39 cm2/m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625–633 2017 AASLD.

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Tài liệu tham khảo

2014, Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography, J Hepatol, 60, 1151, 10.1016/j.jhep.2014.02.026

2013, Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma, J Clin Gastroenterol, 47, 861, 10.1097/MCG.0b013e318293a825

2012, Muscle wasting is associated with mortality in patients with cirrhosis, Clin Gastroenterol Hepatol, 10, 166, 10.1016/j.cgh.2011.08.028

2012, Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value, Liver Transpl, 18, 1209, 10.1002/lt.23495

2013, Association between sarcopenia and the risk of serious infection among adults undergoing liver transplantation, Liver Transpl, 19, 1396, 10.1002/lt.23752

2017, Malnutrition and sarcopenia predict post‐liver transplantation outcomes independently of the Model for End‐Stage Liver Disease score, J Cachexia Sarcopenia Muscle, 8, 113, 10.1002/jcsm.12095

2013, Muscle mass predicts outcomes following liver transplantation, Liver Transpl, 19, 1172, 10.1002/lt.23724

2010, Sarcopenia and mortality after liver transplantation, J Am Coll Surg, 211, 271, 10.1016/j.jamcollsurg.2010.03.039

2014, Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation, Liver Transpl, 20, 1413, 10.1002/lt.23970

2014, Sarcopenia is a prognostic factor in living donor liver transplantation, Liver Transpl, 20, 401, 10.1002/lt.23811

2014, Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation, Liver Transpl, 20, 640, 10.1002/lt.23863

2016, Sarcopenia from mechanism to diagnosis and treatment in liver disease, J Hepatol, 65, 1232, 10.1016/j.jhep.2016.07.040

2008, Development of imaging methods to assess adiposity and metabolism, Int J Obes (Lond), 32, S76

1998, Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography, J Appl Physiol (1985), 85, 115, 10.1152/jappl.1998.85.1.115

2004, Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross‐sectional image, J Appl Physiol (1985), 97, 2333, 10.1152/japplphysiol.00744.2004

2008, Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population‐based study, Lancet Oncol, 9, 629, 10.1016/S1470-2045(08)70153-0

2013, Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index, J Clin Oncol, 31, 1539, 10.1200/JCO.2012.45.2722

2015, Inclusion of sarcopenia within MELD (MELD‐sarcopenia) and the prediction of mortality in patients with cirrhosis, Clin Transl Gastroenterol, 6, e102, 10.1038/ctg.2015.31

2015, Relationship between sarcopenia, six‐minute walk distance and health‐related quality of life in liver transplant candidates, Clin Transplant, 29, 134, 10.1111/ctr.12493

2014, Post‐liver transplantation sarcopenia in cirrhosis: a prospective evaluation, J Gastroenterol Hepatol, 29, 1250, 10.1111/jgh.12524

2007, NIH ImageJ and Slice‐O‐Matic computed tomography imaging software to quantify soft tissue, Obesity (Silver Spring), 15, 370, 10.1038/oby.2007.573

2015, Profile of plasma amino acids values as a predictor of sepsis in patients following living donor liver transplantation: special reference to sarcopenia and postoperative early nutrition, Hepatol Res, 45, 1170, 10.1111/hepr.12484

2016, Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis, J Cachexia Sarcopenia Muscle, 7, 126, 10.1002/jcsm.12039

2016, Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi‐continent study, J Cachexia Sarcopenia Muscle, 7, 312, 10.1002/jcsm.12076

2014, Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia, J Am Med Dir Assoc, 15, 95, 10.1016/j.jamda.2013.11.025

2010, Ethnicity‐related skeletal muscle differences across the lifespan, Am J Hum Biol, 22, 76, 10.1002/ajhb.20956

2008, Disparities in liver transplantation before and after introduction of the MELD score, JAMA, 300, 2371, 10.1001/jama.2008.720

2010, Height contributes to the gender difference in wait‐list mortality under the MELD‐based liver allocation system, Am J Transplant, 10, 2658, 10.1111/j.1600-6143.2010.03326.x

2016, Systematic review and meta‐analysis of the impact of computed tomography‐assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation, Am J Transplant, 16, 2277, 10.1111/ajt.13732

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Liver Transplantation

Tập 23 Số 5

625-633

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