Low psoas muscle index associates with long-term mortality in cirrhosis: construction of a nomogram

Abstract

Background: To develop a nomogram incorporating indicator of muscle waste to prognosticate long-term mortality in liver cirrhosis (LC), and identify the prognostic impact of psoas muscle index (PMI).Methods: A total of 251 LC patients who underwent computed tomography were included in this study.Multiple Cox regression was performed, and sex-specific nomogram models incorporating PMI were developed. The utility of the proposed models were evaluated by Harrell's concordance index (C-index), calibration curve and decision curve analysis. X-tile was used to determine optimal cutpoint for stratifying subjects with distinct outcomes. Subgroup analysis was implemented in terms of age and MELD score. The correlation between PMI and gait speed was also evaluated.Results: On multiple analysis, independent predictors for 3-year all-cause mortality were age, BMI, PMI and MELD for males, and age, PMI and MELD for females. Both nomogram models gave rise to moderately strong discrimination, with a C-index of 0.792 (95% CI: 0.723-0.861) in males and 0.715 (95% CI: 0.637-0.793) in females, respectively. The calibration curve implied predicted survival corresponding optimally with the actual outcomes. The proposed models were feasible in clinical settings based on decision curve analysis. On subgroup analysis, PMI might confer valid predictive value on LC patients with MELD <15. Moreover, a definitely positive correlation between PMI and gait speed was revealed.Conclusions: Our proposed nomogram embedding PMI rendered an individualized predictive tool for long-term mortality in LC. The diminishing value of PMI is likely indicative of muscle dysfunction.

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

“…Sarcopenia assessed by psoas muscle index is a simple and practical method that should be helpful to estimate patient frailty and to predict surgical outcome not only for oncological patients. It’s utility was demonstrated in liver transplantation [ 26 ], complication prediction in resected non-small-cell-lung-carcinoma [ 27 ], a prognostic value in primary operable colorectal cancer [ 28 ] and advanced or recurrent colorectal cancer treated with regorafenib [ 29 ], ICU (Instesive Care Unit) stay predictor in trauma patients [ 30 ], gynecological malignant diseases [ 31 ] as in liver cirrhosis, when PMI is a predictive tool for long term mortality [ 32 ]. In a study conducted by Y. Zager et al the radiological measurement of psoas area proved to be important as in Crohn’s disease among patients with bowel resection.…”

Definition of Sarcopenia in Chronic Liver Disease

“…Second, normalization is not uniform. Among the studies using PMA, some studies used the PMA [54,55,58], and other studies used the PMI, in which PMA is normalized by the squared height [56,57,[59][60][61][62]. In studies using the TPMT, the TPMT is normalized by height [14,33,52,53,63].…”

Psoas Muscle Index Can Be Used to Predict Long-Term Mortality in Young Male Patients With Acute-on-Chronic Liver Failure

“…Sarcopenia is a major feature of malnutrition in patients with liver disease and is an important indicator affecting the prognosis of patients with end-stage liver disease (ESLD) (1). Numerous studies (2-5) have used the skeletal muscle index at the third lumbar vertebrae (L3-SMI) to determine sarcopenia, to further evaluate the association between sarcopenia and the prognosis of patients with chronic liver disease (CLD), and also some studies have evaluated the impact of the psoas muscle index (PMI) on the prognosis of CLD (6,7). Studies (8)(9)(10)(11) have shown that sarcopenia can be valuable as a predictor of disease progression, complications of cirrhosis such as the incidence of hepatic encephalopathy, mortality of cirrhotic patients, long-term outcome after liver transplantation, and outcome of patients with HCC.…”