A Comparison of Muscle Function, Mass, and Quality in Liver Transplant Candidates

Abstract

Background Sarcopenia and functional impairment are common and lethal extra-hepatic manifestations of cirrhosis. We aimed to determine the association between computed-tomography (CT)-based measures of muscle mass and quality (sarcopenia) and performance-based measures of muscle function. Methods Adults listed for liver transplant underwent testing of muscle function [grip strength, Short Physical Performance Battery (SPPB)] within 3 months of abdominal CT. Muscle mass (cm2/m2) =total cross-sectional area of psoas, paraspinal, and abdominal wall muscles at L3 on CT, normalized for height. Muscle quality=mean Hounsfield units (HU) for total skeletal muscle area at L3. Results Among 292 candidates, median grip strength was 31kg, SPPB score was 11, muscle mass was 49cm2/m2, and muscle quality was 35HU. Grip strength weakly correlated with muscle mass (ρ=0.26, p<0.001) and quality (ρ=0.27; p<0.001) in men, and muscle quality (ρ=0.23, p=0.02), but not muscle mass, in women. SPPB correlated weakly with muscle quality in men (ρ=0.38; p<0.001) and women (ρ=0.25; p=0.02), however did not correlate with muscle mass in men or women. After adjustment for gender, MELD-Na, hepatocellular carcinoma, and BMI, grip strength (HR 0.74, 95%CI 0.59–0.92, p=0.008), SPPB (HR 0.89, 95%CI 0.82–0.97, p=0.01), and muscle quality (HR 0.77, 95%CI 0.63–0.95, p=0.02) were associated with wait-list mortality, but muscle mass was not (HR 0.91, 95%CI 0.75–1.11, p=0.35). Conclusions Performance-based tests of muscle function are only modestly associated with CT-based muscle measures. Given that they predict wait-list mortality and can be conducted quickly and economically, tests of muscle function may have greater clinical utility than CT-based measures of sarcopenia.

Walking Speed: Japanese Data in Chronic Liver Diseases

“…Both maintained cognitive function and muscle strength may be necessary for the improvement of WS, while even if cognitive function is reduced, the HGS value will not decrease as long as muscle strength is maintained [20,34]. While the correlation coefficient between the WS value and SMI was not impressive compared with that between the WS value and the HGS value, muscle function and muscle mass may play different roles for the development of sarcopenia [19,30].…”

“…Physical activity has been considered a factor of interest in recent research. Previous data indicate that functional measures of muscle strength may have better predictability for outcomes than CT-based measures of skeletal muscle mass in LC patients [30]. As mentioned earlier, the current JSH guidelines for sarcopenia in CLDs adopt not WS but only HGS for the assessment of muscle strength decline and few research papers report data for WS in Japanese CLD patients [10,18,19].…”

Editorial: Advancing Adoption of Frailty to Improve the Care of Patients with Cirrhosis: Time for a Consensus on a Frailty Index

“…Can the frail phenotype, defined by an arbitrary cut-point on an ordinal scale that captures the clinicians’ assessment of the patient (i.e., Clinical Frailty Scale), really be the same as the frail phenotype defined by a continuous, performance-based assessment of gait speed? What should we conclude of the fact that neither hand grip strength nor the Braden Scale, tools that have previously been shown to predict mortality in cirrhotics, 5,6 were not significantly associated with an increased risk of hospitalizations? 1 …”

The Use of Technology for Estimating Body Composition

“…Therefore, the application is limited to individuals who have had CT scans completed as part of their medical treatment. To date, most published research using CT scans for body composition assessment is retrospective and has been conducted in cancer populations, 12 – 16 but recent work has extended this to other clinical populations 17 – 23 …”