Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

Abstract

Hepatic encephalopathy (HE) is a late complication of liver cirrhosis and is clearly associated with poor outcomes. Chronic liver insufficiency leads to progressive muscle wasting, impairing ammonia metabolism and thus increasing the risk for HE. Given the association between lean mass and adductor pollicis muscle thickness (APMT), it has been used to predict outcome and complications in many conditions, but not yet in cirrhotic patients. Therefore, this article aimed to study the association between HE manifestations and measures related to muscle mass and strength. This cross-sectional study included 54 cirrhotic outpatients with HE varying from subclinical to grade II according to the West-Haven criteria, who were submitted to neuropsychometric tests, electroencephalogram, brain Single Photon Emission Computed Tomography (SPECT), anthropometric measurements, handgrip strength (HGS) and dual energy X-ray absorptiometry exam (DXA). Multiple logistic regression analysis was performed to investigate the association between body composition measures and HE grade. Analysis of the area under the receiver operator characteristic (AUROC) curve revealed the values related to neurological manifestations (HE grades I and II). Reductions in APMT and HGS were associated with higher HE grades, suggesting a big impact caused by the loss of muscle mass and function on HE severity. The link between HE manifestations and anthropometric measures, namely APMT and HGS, point to a significant relation concerning skeletal muscles and the neurological impairment in this population.

Adductor Pollicis Muscle Thickness and Obesity Are Associated with Poor Outcome after Stroke: A Cohort Study

“…28,29 In cirrhotic patients, lower amounts of APMT were associated with higher degrees of hepatic encephalopathy. 30 In our study, we found a mean APMT value of 13.7 ± 4.2 mm in patients with mRS <3. The value we found was similar to a study of 421 healthy individuals conducted to standardize the measurement of APMT in healthy adults, with values of 12.5 ± 2.8 mm for men and 10.5 ± 2.3 mm for women.…”

“…4,26 In addition, in diseases such as surgical, critical, and cirrhotic patients, the APMT was associated to poor prognosis. [27][28][29][30] The present study hypothesized that APM is a potential tool to predict prognosis after stroke. From now on, it will be necessary to carry out new studies on a larger scale to prove this applicability.…”

Nutritional assessment, handgrip strength and adductor pollicis muscle thickness in patients with chronic viral hepatitis

“…Augusti et al first compared HGS, APMT and other anthropometric measurements with the lean body mass gold-standard (DEXA) in patients with cirrhosis. They found the relation between the lowest values of HGS and APMT (20.5 kgf and 6.5 mm, respectively) and emergence of hepatic encephalopathy [42]. Nevertheless, there is no prognostic evidence in chronic liver disease patients without cirrhosis [42e44].…”

Anthropometric measures associated with sarcopenia in outpatients with liver cirrhosis

“…In prior studies published by our group, as well as by other authors, hepatic encephalopathy manifestations were more evident in patients with muscle depletion diagnosed by MAMC and/or in those with reduced HGS. 33,34 Despite the role of skeletal muscle in ammonia metabolism in the context of liver diseases and the subsequent impact of muscle loss on hepatic encephalopathy, few studies have evaluated the link between this complication and the presence of sarcopenia. An interesting study showed that a low fat-free mass index and low haemoglobin levels were predictors of hepatic encephalopathy among patients waiting for liver transplantation.…”