Muscle fat infiltration assessed by total psoas density on computed tomography predicts mortality in cirrhosis

Maria Kalafateli; Andreas Karatzas; Georgios Tsiaoussis; Efstratios Koutroubakis; Paraskevi Tselekouni; Nikolaos Koukias; Christos Konstantakis; Stelios Assimakopoulos; Charalambos Gogos; Konstantinos Thomopoulos; Christina Kalogeropoulou; Christos Triantos

Authors Maria Kalafateli, Andreas Karatzas, Georgios Tsiaoussis, Efstratios Koutroubakis, Paraskevi Tselekouni, Nikolaos Koukias, Christos Konstantakis, Stelios Assimakopoulos, Charalambos Gogos, Konstantinos Thomopoulos, Christina Kalogeropoulou, Christos Triantos.

Abstract

Background Ongoing evidence suggests that sarcopenia adversely affects outcomes in cirrhosis.
The aim of this study was to evaluate muscle fat infiltration as a component of sarcopenia and its
prognostic value in this setting.

Methods In 98 consecutive patients with cirrhosis, muscle density was measured during a computed tomography scan at the level of the fourth to fifth lumbar (L4) vertebrae. Univariate and multivariate Cox regression analysis was used to determine predictors of survival.

Results Body mass index: median 26 (range 17-45.2); model for end-stage liver disease (MELD) score: median 11 (6-29); Child-Pugh (CP) score: median 7 (5-13), CP class: A=49 (50.5%), B=39 (40%), C=10 (9.5%); hepatocellular carcinoma: 14 (14.3%); follow up: median 45 (1-140) months. Median L4 total psoas area (TPA): 2022 (777-3806) mm2; L4 average total psoas density (ATPD): 42.52 (21.26- 59.8) HU. ATPD was significantly correlated with age (r=-0.222, P=0.034), creatinine (r=-0.41, P<0.001), albumin (r=0.224, P=0.035), MELD score (r=-0.218, P=0.034), and TPA (r=0.415, P<0.001). Fifty-four patients (55.1%) died during follow up. In the multivariate analysis, higher CP score (hazard ratio [HR] 1.2, 95% confidence interval [CI] 1.04-1.41), advanced age (HR 1.038, 95%CI 1.006-1.07) and lower ATPD (HR 0.967, 95%CI 0.937-0.997) were predictors of mortality.

Conclusion Muscle fat infiltration, as a result of sarcopenia, is a negative predictive factor of survival in cirrhosis, emphasizing the need for early identification of this subgroup of patients.

Keywords Sarcopenia, nutrition, analytic morphometry

Ann Gastroenterol 2018; 31 (4): 491-498