Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis

Praktiknjo, Michael; Book, Marius; Luetkens, Julian A.; Pohlmann, Alessandra; Meyer, Carsten H.; Thomas, Daniel; Jansen, Christian; Feist, Andreas; Chang, Johannes; Grimm, Jochen; Lehmann, Jennifer; Strassburg, Christian P.; Abraldes, Juan G.; Kukuk, Guido; Trebicka, Jonel

doi:10.1002/hep.29602

Cited by 130 publications

(163 citation statements)

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“…Of 67 records identified through search query and two identified through other sources, 45 were excluded from title and abstract, while the remaining 24 were downloaded for a deeper assessment. Finally, a total of 18 articles matched the topic at issue …”

Section: Resultsmentioning

confidence: 99%

“…Study design was prospective in 14/18 (78%) articles and retrospective in 4/18 (22%), and articles were published between 2012 and 2018. The number of published articles per year is presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Stratifying studies according to their aim, 13/18 studies (72%) focused on muscle quantity and quality (MQQ), 3/18 (17%) on clinical outcome prediction, while both aims where addressed in 2/18 articles (11%) …”

Section: Resultsmentioning

confidence: 99%

“…Body region analyzed were trunk for all articles. Regarding the MRI‐derived biomarkers, muscles CSA was used in 3/5 articles (60%), while the fat area or fat‐free mass area was used in the remaining 2/5 (40%) …”

Section: Resultsmentioning

confidence: 99%

“…Sarcopenia was predictive of adverse outcome in most studies . In particular, Jang et al demonstrated that sarcopenic obesity assessed through MRI is a strong predictor of postoperative pancreatic fistula (odds ratio 2.65, 95% confidence interval [CI] 1.43–4.93) .…”

Section: Resultsmentioning

confidence: 99%

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MRI‐Derived Biomarkers Related to Sarcopenia: A Systematic Review

Codari

Zanardo

Sabato

et al. 2019

Magnetic Resonance Imaging

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Background MRI allows quantitatively assessing muscle quantity and quality. Purpose To summarize the role of MRI as a noninvasive technique for the identification of in vivo surrogate biomarker of sarcopenia. Study Type Systematic review. Population In April 2019, a systematic literature search (Medline/EMBASE) was performed to identify articles on the topic at issue. Field Strength/Sequence No field strength or sequence restrictions. Assessment After a literature search, study design, aim, sample size, demographics, magnetic field strength, imaged body region, MRI sequences, and imaging biomarker were extracted. Statistical Tests Data are presented as frequencies and percentages. Results From 69 records identified through search query, 18 articles matched the inclusion criteria. All articles were published from 2012 and had a mainly prospective design (14/18, 78%). Sample size ranged from 9 to 284 subjects, for a total of 1706 enrolled subjects. Healthy subjects were enrolled or retrospectively selected in 8/18 (44%) articles, corresponding to 658 (39%) healthy subjects. Magnetic field strength was 1.5 or 3T in 14/18 (78%) studies. The most analyzed body regions were the thigh (7/18, 39%) and the trunk (6/18, 33%). Stratifying studies according to their aim, 13/18 (72%) studies focused on muscle quality and quantity, 3/18 (17%) studies on outcome prediction, and 2/18 articles (11%) addressed both aims. A wide set of MRI biomarkers have been proposed. Muscle cross‐sectional area was the most used for muscle quantity estimation, while quantitative biomarkers of muscle fat content or fiber architecture were proposed to assess muscle quality. Data Conclusion The proposed biomarkers were assessed using different MRI sequences for different body regions in different subjects/patient cohorts, pointing out a lack of standardization on this topic. Future studies should test and compare the performance of proposed MRI biomarkers for sarcopenia characterization and quantification using a standardized experimental setup. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1117–1127.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

MRI‐Derived Biomarkers Related to Sarcopenia: A Systematic Review

Codari

Zanardo

Sabato

et al. 2019

Magnetic Resonance Imaging

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Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis

et al. 2019

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Muscle alterations (myosteatosis and sarcopenia) are frequent in cirrhosis and related to some complications including overt hepatic encephalopathy (HE). The aim of our study was to investigate the relationship between muscle alterations and minimal HE (MHE) and their role in the risk of overt HE. Sixty-four patients with cirrhosis were administered the Psychometric Hepatic Encephalopathy Score and animal naming test to detect MHE. Computed tomography was used to analyze the skeletal muscle index and attenuation. The incidence of the first episode of HE, taking into account the competing risk nature of the data, was estimated. Myosteatosis was observed in 24 patients (37.5%), sarcopenia in 37 (58%), and MHE in 32 (50%). Both myosteatosis (62.5% versus 12.5%, P < 0.001) and sarcopenia (84% versus 31%, P < 0.001) were more frequent in patients with MHE. The variables independently associated with the presence of MHE were sarcopenia, previous overt HE, and myosteatosis. Thirty-one (48%) patients developed overt HE over 16.1 ± 13 months; myosteatosis was detected in 68% and sarcopenia in 84% of them. Sarcopenia and myosteatosis were also independently associated with the development of overt HE. Venous ammonia was significantly higher in patients with sarcopenia (62.6 ± 17.7 versus 41.4 ± 16.1 μg/dL, P < 0.001) and in patients with myosteatosis (65.2 ± 19.2 versus 46.7 ± 17.1 μg/dL, P < 0.001) and inversely correlated to both parameters. Survival was significantly lower in malnourished patients compared to patients without myosteatosis or sarcopenia (P < 0.001). Conclusion: Myosteatosis and sarcopenia, probably by reducing the handling of ammonia in the muscle, are independently associated with MHE and the risk of overt HE in patients with cirrhosis; in malnourished patients, the amelioration of nutritional status may be a goal to decrease both the prevalence of MHE and the incidence of overt HE.

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A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation

et al. 2019

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Loss of muscle mass and function, or sarcopenia, is a common feature of cirrhosis and contributes significantly to morbidity and mortality in this population. Sarcopenia is a main indicator of adverse outcomes in this population, including poor quality of life, hepatic decompensation, mortality in patients with cirrhosis evaluated for liver transplantation (LT), longer hospital and intensive care unit stay, higher incidence of infection following LT, and higher overall health care cost. Although it is clear that muscle mass is an important predictor of LT outcomes, many questions remain, including the best modality for assessing muscle mass, the optimal cut-off values for sarcopenia, the ideal timing and frequency of muscle mass assessment, and how to best incorporate the concept of sarcopenia into clinical decision making. For these reasons, we assembled a group of experts to form the North American Working Group on Sarcopenia in Liver Transplantation to use evidence from the medical literature to address these outstanding questions regarding sarcopenia in LT. We believe sarcopenia assessment should be considered in all patients with cirrhosis evaluated for liver transplantation. Skeletal muscle index (SMI) assessed by computed tomography constitutes the best-studied technique for assessing sarcopenia in patients with cirrhosis. Cut-off values for sarcopenia, defined as SMI < 50 cm 2 /m 2 in male and < 39 cm 2 /m 2 in female patients, constitute the validated definition for sarcopenia in patients with cirrhosis. Conclusion: The management of sarcopenia requires a multipronged approach including nutrition, exercise, and additional pharmacological therapy as deemed necessary. Future studies should evaluate whether recovery of sarcopenia with nutritional management in combination with an exercise program is sustainable as well as how improvement in muscle mass might be associated with improvement in clinical outcomes.

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Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis

Cited by 130 publications

References 47 publications

MRI‐Derived Biomarkers Related to Sarcopenia: A Systematic Review

MRI‐Derived Biomarkers Related to Sarcopenia: A Systematic Review

Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis

A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation

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