A Model to Identify Sarcopenia in Patients With Cirrhosis

Tandon, Puneeta; Low, Gavin; Mourtzakis, Marina; Zenith, Laura; Myers, Robert P.; Abraldes, Juan G.; Shaheen, Abdel Aziz; Qamar, Hina; Mansoor, Nadia; Carbonneau, Michelle; Mann, Sumeer A.; Alaboudy, Alshimaa; Ma, Mang

doi:10.1016/j.cgh.2016.04.040

Cited by 183 publications

(212 citation statements)

References 33 publications

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“…Previously published studies demonstrating such a link have examined the 6‐Minute Walk Test, handgrip strength, short physical performance battery, subjective global assessment, psoas muscle thickness on CT, transverse muscle area on CT, and DEXA LM measures . This study is unique in its analysis of different diagnostic methods in a single cohort of patients with most previous studies employing single‐slice CT scans at the L3 level …”

Section: Discussionmentioning

confidence: 99%

Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

Sinclair

Chapman

Hoermann³

et al. 2019

Liver Transpl

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Sarcopenia is associated with mortality in cirrhosis, but there is no gold standard for its diagnosis. The comparative utility of different diagnostic methods is unknown. This single‐center observational cohort study followed 145 men referred for liver transplant evaluation between 2005 and 2012. Muscle mass was estimated by handgrip strength, dual energy X‐ray absorptiometry (DEXA) lean mass, and single‐slice computed tomography (CT) scan at the fourth lumbar vertebra. Recorded outcomes included time to death or liver transplantation. The median (interquartile range [IQR]) age was 54 years (47‐59 years), and Model for End‐Stage Liver Disease (MELD) score was 17 (14‐23). Of 145 men, 56 died with a median (IQR) time to death of 7.44 months (3.48‐14.16 months). In total, 79 men underwent transplantation with median (IQR) time to transplant of 7.20 months (3.96‐12.84 months). The prevalence of sarcopenia differed between diagnostic modalities with 70.3% using CT muscle mass, 45.9% using handgrip strength, and 38.7% using DEXA. Muscle mass was inversely associated with wait‐list mortality for measured CT muscle mass (hazard ratio [HR], 0.94; 95% confidence interval (CI), 0.90‐0.98; P = 0.002), DEXA muscle mass (HR, 0.99; 95% CI, 0.99‐0.99; P = 0.003), and handgrip strength (HR, 0.94; 95% CI, 0.91‐0.98; P = 0.002). These results retained significance independent of the MELD score. In predicting mortality, the MELD–handgrip strength bivariate Cox model was superior to a MELD‐CT muscle Cox model (P < 0.001). In conclusion, handgrip strength combined with MELD score was the superior predictive model in this novel study examining 3 commonly employed techniques to diagnose sarcopenia in cirrhosis. Handgrip strength has additional potential clinical benefits because it can be performed serially without the radiation dose, cost, and access issues attributable to CT and DEXA.

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Section: Discussionmentioning

confidence: 99%

Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

Sinclair

Chapman

Hoermann³

et al. 2019

Liver Transpl

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“…However, the results obtained by BIA present low sensitivity as they are highly influenced by fluid retention, especially edema, or shifts, such as ascites, which may give misleading information on muscle and adipose tissues changes. Therefore, its use in cross-sectional and longitudinal evaluation of cirrhosis is not currently recommended [29]. Considering these limitations, a study by Fernandes et al recently analyzed the specific role of phase angle (PA), obtained by BIA, which was studied in different trials.…”

Section: Nutritional Assessment In Cirrhosismentioning

confidence: 99%

“…Preliminary data showed that BMI and thigh muscle thickness, as documented by ultrasound imaging, are good predictors of sarcopenia in cirrhosis [29]. …”

Section: Nutritional Assessment In Cirrhosismentioning

confidence: 99%

“…The SGA was implemented in cirrhotic patients with and without hepatocellular carcinoma resulting as a good predictor of nutritional status [45], considering that in patients with cirrhosis weight and biochemical values may vary with the severity of the underlying liver disease [46]. Nevertheless, this tool, despite being relatively simple, could be fairly inaccurate, because it underestimates the prevalence of sarcopenia in cirrhosis [29]. In a recent study on 69 patients diagnosed with sarcopenia by imaging technique, only 46% were moderately or severely malnourished according to SGA, indicating the limited capacity of this tool in assessing nutritional status [29].…”

Section: Nutritional Assessment In Cirrhosismentioning

confidence: 99%

“…Nevertheless, this tool, despite being relatively simple, could be fairly inaccurate, because it underestimates the prevalence of sarcopenia in cirrhosis [29]. In a recent study on 69 patients diagnosed with sarcopenia by imaging technique, only 46% were moderately or severely malnourished according to SGA, indicating the limited capacity of this tool in assessing nutritional status [29]. The Royal Free Hospital SGA represents a modification of the traditional SGA.…”

Section: Nutritional Assessment In Cirrhosismentioning

confidence: 99%

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The Challenges of Nutritional Assessment in Cirrhosis

2017

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Purpose of Review Nutritional status in patients with cirrhosis is very frequently associated with macro- and micronutrient deficiencies. Cirrhosis itself is the cause of malnutrition and nutritional deficiencies but these conditions have to be identified and addressed properly as they can worsen the prognosis of cirrhosis. The goals of this review are to 1) identify and describe the challenges associated with nutritional assessment in cirrhosis and 2) describe recent advancements when using clinical, laboratory, and instrumental tools in the evaluation of malnourished patients with liver diseases. Recent Findings The most promising tools for nutritional assessment in cirrhosis include the evaluation of body composition with phase angle obtained by bioelectrical impedance analysis, computed tomography transverse images at the level of third lumbar vertebra. The Royal-Free Hospital global assessment algorithm appears to be helpful but needs further validation. Summary Nutritional assessment in cirrhosis is challenging as several factors, including edema, can interfere with it and because of lack of a validated gold standard. Regardless, nutritional assessment methods have been developed in recent years and should gain relevance in the clinical practice.

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Sarcopenia Assessment Techniques

Guttikonda

Smith

2021

Clinical Liver Disease

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A Model to Identify Sarcopenia in Patients With Cirrhosis

Cited by 183 publications

References 33 publications

Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

The Challenges of Nutritional Assessment in Cirrhosis

Sarcopenia Assessment Techniques

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