A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort

Vugt, Jeroen L.A. van; Alferink, Louise J.M.; Buettner, Stefan; Gaspersz, M.; Bot, D.; Murad, Sarwa Darwish; Feshtali, Shirin; Ooijen, Peter M. A. van; Polak, Wojciech; Porte, Robert J.; Hoek, Bart van; Berg, Aad P. van den; Metselaar, Herold J.; IJzermans, Jan N. M.

doi:10.1016/j.jhep.2017.11.030

Cited by 176 publications

(151 citation statements)

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“…1. A total of 38 articles (years 2010-2018) were included, (1,(3)(4)(5)(6)(9)(10)(11)(12) in which 92% (n = 35) were conducted in adults (1,(3)(4)(5)(6)11,12,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(35)(36)(37)(38)(39)(40)(41)(42)(43) and 8% (n = 3) were conducted in pediatric populations. (9,10,34)…”

Section: Resultsmentioning

confidence: 99%

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

et al. 2019

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Malnutrition is a common complication in patients with end‐stage liver disease (ESLD) awaiting liver transplantation (LT). Malnutrition and sarcopenia overlap in etiology and outcomes, with sarcopenia being defined as reduced skeletal muscle mass and muscle function. The purpose of this review was to identify the prevalence of sarcopenia with and without obesity in adults and children with ESLD and to assess the methodological considerations in sarcopenia diagnosis and the association of sarcopenia with pre‐ and post‐LT outcomes. A total of 38 articles (35 adult and 3 pediatric articles) retrieved from PubMed or Web of Science databases were included. In adults, the prevalence rates of pre‐LT sarcopenia, pre‐LT sarcopenic obesity (SO), post‐LT sarcopenia, and post‐LT SO were 14%‐78%, 2%‐42%, 30%‐100%, and 88%, respectively. Only 2 adult studies assessed muscle function in patients diagnosed with sarcopenia. The presence of pre‐LT sarcopenia is associated with higher wait‐list mortality, greater postoperative mortality, higher infection risk and postoperative complications, longer intensive care unit (ICU) stay, and ventilator dependency. The emerging pediatric data suggest that sarcopenia is prevalent in pre‐ and post‐LT periods. In 1 pediatric study, sarcopenia was associated with poor growth, longer perioperative length of stay (total/ICU) and ventilator dependency, and increased rehospitalization in children after LT. In conclusion, there is a high prevalence of sarcopenia in adults and children with ESLD. Sarcopenia is associated with adverse clinical outcomes. The present review is limited by heterogeneity in the definition of sarcopenia and in the methodological approaches in assessing sarcopenia. Future studies are needed to standardize the sarcopenia diagnosis and muscle function assessment, particularly in the pediatric population, to enable early identification and treatment of sarcopenia in adults and children with ESLD.

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Section: Resultsmentioning

confidence: 99%

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

et al. 2019

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“…Although sarcopenia is not a current criterion for expedited LT, giving some priority to those patients with sarcopenia may help to decrease mortality in a subgroup of patients with cirrhosis. 3,29 Sarcopenia is one of the major manifestations of protein-energy malnutrition in cachexiaassociated diseases, and to prevent adverse clinical implications, early and proper identification of patients with sarcopenia should be implanted and intense nutritional and physical interventions should be included to improve patient conditions and to lessen mortality risk in patients with higher risk as determined by low SMI.…”

Section: Discussionmentioning

confidence: 99%

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Ebadi

Wang

Lai

et al. 2018

J cachexia sarcopenia muscle

109

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BackgroundSarcopenia, characterized by low muscle mass, associates with mortality in patients with cirrhosis. Skeletal muscle area in a single computed tomography image at the level of the third lumbar vertebrate (L3) is a valid representative of whole body muscle mass. Controversy remains regarding applicability of psoas muscle to identify patients at greater risk of mortality. We aimed to determine psoas muscle index (PMI) association with skeletal muscle index (SMI) and to evaluate the capacity of PMI to predict liver transplant waitlist mortality.MethodsWe evaluated listed adult patients with cirrhosis from 2012 to 2013 at four North American liver transplant centres. From L3 computed tomography images within 3 months of listing, we determined SMI and PMI expressed by cm2/m2. Low SMI was defined as SMI <39 cm2/m2 in women and <50 cm2/m2 in men as published by us earlier. Cut‐offs for PMI to predict mortality were established using a receiver‐operating characteristic analysis. Mortality predictors were determined using competing‐risk analysis with reported results as subdistribution hazard ratios (sHRs).ResultsOf 353 waitlist candidates, 68% were men, mean age 56 ± 9 years, and Model for End‐stage Liver Disease of 16 ± 8 points. Low SMI was present more frequently in men than women (51 vs. 36%, P = 0.02). Moderately strong correlation between SMI and PMI was observed (r > 0.7, P < 0.001). Low PMI (males < 5.1 cm2/m2; females < 4.3 cm2/m2) yielded poor and moderate concordance with low SMI in men and women, respectively (Kappa coefficient 0.31 and 0.63). SMI (39 ± 9 vs. 43 ± 7 cm2/m2; P = 0.009) and PMI (4.4 ± 1.3 vs. 5.2 ± 1.1 cm2/m2; P = 0.001) were lower in women who died and/or were delisted (compared with non‐deceased patients) whereas men who died and/or were delisted had only lower SMI (47 ± 7 vs. 51 ± 9 cm2/m2; P = 0.003), but not PMI compared with non‐deceased patients. In women, both SMI (sHR 0.94, P = 0.048) and PMI (sHR 0.58, P = 0.002) were predictors of mortality, while in men, SMI was significant (sHR 0.95, P = 0.001) and PMI showed a trend to be (sHR 0.85, P = 0.09) associated with mortality. Overall, 104 patients (29%) were misclassified between SMI and PMI categories. Using PMI cut‐offs, 66% and 28% of low SMI men and women, who have a higher risk of mortality, were incorrectly classified as low risk.ConclusionsSkeletal muscle index is a more complete and robust measurement than PMI, especially in men with cirrhosis. Low PMI identifies an incomplete subset of patients at increased risk of mortality indicated by low SMI. Given the poor performance of PMI, SMI should not be substituted by PMI.

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“…The role of sarcopenia as an effective predictor of postoperative complications has been reported in many clinical studies [51][52][53]. In patients with end-stage liver disease and awaiting transplantation, a model including sarcopenia could even surpass the MELD score in predicting waiting list mortality [54]. A variety of studies [19,30,32] have also explored the role of sarcopenia in the occurrence of complications in patients undergoing hepatopancreatobiliary surgery.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort

Cited by 176 publications

References 36 publications

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

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