Combination of Fat-Free Muscle Index and Total Spontaneous Portosystemic Shunt Area Identifies High-Risk Cirrhosis Patients.

Autor:	Faron A; Department of Radiology, University Hospital Bonn, Bonn, Germany., Abu-Omar J; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Chang J; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Böhling N; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Sprinkart AM; Department of Radiology, University Hospital Bonn, Bonn, Germany., Attenberger U; Department of Radiology, University Hospital Bonn, Bonn, Germany., Rockstroh JK; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Luu AM; Department of Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany., Jansen C; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Strassburg CP; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Trebicka J; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany.; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain., Luetkens J; Department of Radiology, University Hospital Bonn, Bonn, Germany., Praktiknjo M; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2022 Apr 12; Vol. 9, pp. 831005. Date of Electronic Publication: 2022 Apr 12 (Print Publication: 2022).
DOI:	10.3389/fmed.2022.831005
Abstrakt:	Background: Sarcopenia and spontaneous portosystemic shunts (SPSSs) are common complications of liver cirrhosis, and both are associated with higher rates of hepatic encephalopathy (HE) development in these patients. This study aimed to evaluate the simultaneous impact of skeletal muscle mass and spontaneous portosystemic shunting, measured from routine diagnostic CT on outcomes in patients with liver cirrhosis. Methods: Retrospective analysis of patients with cirrhosis. Skeletal muscle mass [including fat-free muscle index (FFMI) as a surrogate for sarcopenia] and total cross-sectional spontaneous portosystemic shunt area (TSA) were quantified from CT scans. The primary endpoint was the development of HE, while the secondary endpoint was 1-year mortality. Results: One hundred fifty-six patients with liver cirrhosis were included. Patients with low (L-) FFMI and large (L-)TSA showed higher rates of HE development. In multivariable analysis, L-FFMI and L-TSA were independent predictors of HE development (L-FFMI HR = 2.69, CI 1.22-5.93; L-TSA, HR = 2.50, CI = 1.24-4.72) and 1-year mortality (L-FFMI, HR = 7.68, CI 1.75-33.74; L-TSA, HR = 3.05, CI 1.32-7.04). The simultaneous presence of L-FFMI and L-TSA exponentially increased the risk of HE development (HR 12.79, CI 2.93-55.86) and 1-year mortality (HR 13.66, CI 1.75-106.50). An easy sequential algorithm including FFMI and TSA identified patients with good, intermediate, and poor prognoses. Conclusion: This study indicates synergy between low skeletal muscle mass and large TSA to predict exponentially increased risk of HE development and mortality in liver cirrhosis. Simultaneous screening for sarcopenia and TSA from routine diagnostic CT may help to improve the identification of high-risk patients using an easy-to-apply algorithm. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT03584204]. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Faron, Abu-Omar, Chang, Böhling, Sprinkart, Attenberger, Rockstroh, Luu, Jansen, Strassburg, Trebicka, Luetkens and Praktiknjo.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu