Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease

Abstract

Background and Aims Sarcopenia or skeletal muscle loss adversely affects outcomes in cirrhosis. The impact of aetiology of liver disease on the severity or the rate of muscle loss is not known. Methods Consecutive, well‐characterized adult patients with cirrhosis due to viral hepatitis (VH), alcoholic liver disease (ALD) or non‐alcoholic fatty liver disease (NAFLD) and non‐diseased controls with at least two temporally distinct abdominal CT (computed tomography) scans were evaluated. Psoas, paraspinal and abdominal wall muscle areas at the L3 vertebra level were quantified on the CT scans. Standardized rate of change in muscle area was expressed as change in area/100 days. Univariate and multivariable analyses were performed to identify contributors to rate of muscle loss and survival. Results Among 83 cirrhotics (NAFLD n = 26, ALD n = 39, VH n = 18), there were 20 (24.1%) deaths over 62.7 ± 41.3 months. The mean percentage change in psoas area was −0.03 ± 0.05/100d in controls and −3.52 ± 0.45/100d in cirrhosis (P < .001). The mean percentage change in psoas area was −1.72 ± 0.27/100d in NAFLD, −5.28 ± 0.86/100d in ALD and −2.29 ± 0.28/100d in VH. Among cirrhotics, patients with ALD had the lowest initial muscle area and most rapid rate of reduction in muscle area. Aetiology of liver disease, model for end‐stage liver disease (MELD) and the rate of loss of muscle area were independent risk factors for survival. Conclusions Aetiology of liver disease is an independent risk factor for sarcopenia with the greatest rate of muscle loss noted in ALD. Survival in cirrhosis was dependent on initial muscle mass, rate of muscle loss and MELD score.

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

“…Most studies to date have used a static measure of sarcopenia, but recent data suggest that sarcopenia is progressive and dynamic measures of rate of muscle loss from serial/longitudinal measures are predictors of clinical outcomes. 43 In children with end-stage liver disease, sarcopenia has been associated with adverse outcomes including growth failure, hospitalizations, infections, and motor delay. 151,155,156 Sarcopenic Obesity Sarcopenic obesity refers to the state of decreased muscle mass in the setting of increased fat mass.…”

Use of skeletal muscle index as a predictor of short-term mortality in patients with acute-on-chronic liver failure

“…We also demonstrated that L3-SMI was not able to predict 3-month mortality in patients with ACLF, consistent with a previous retrospective study 21 , showing that sarcopenia is a risk factor for mortality in patients with compensated advanced chronic liver disease (CLD), but not in decompensated advanced CLD. ACLF is an acute liver decompensation that occurs on the basis of CLD, usually within 4 weeks of onset, but with mild skeletal muscle mass over a short period of time 22 , and the L3-SMI level at baseline is mainly related to the underlying liver disease basis. This study suggests that the effect on short-term mortality in patients with ACLF is on the underlying liver disease basis rather than on the L3-SMI.…”

Sarcopenia and frailty in decompensated cirrhosis

“…50 There is also increasing evidence that ethanol, an aetiological factor for liver disease, directly and indirectly (by aggravating muscle hyperammonaemia) contributes to more severe sarcopenia than observed in other forms of liver disease. 51,52 Of interest, particularly in the setting of decompensated cirrhosis and ACLF, is the potential contribution of endotoxemia-mediated muscle proteolysis and decreased protein synthesis, especially during sepsis and infection. 38 Other mediators including mitochondria-derived factors, PAMPs and DAMPs may also contribute to dysregulated proteostasis, but their mechanistic relevance and contributions have not been reported in cirrhosis.…”