Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Kim, Gaeun; Kang, Seong Hee; Kim, Moon Young; Baik, Soon Koo

doi:10.1371/journal.pone.0186990

Cited by 264 publications

(276 citation statements)

References 57 publications

Supporting

Mentioning

264

Contrasting

Unclassified

Order By: Relevance

“…Hyperammonemia may not only reflect the degree of underlying sarcopenia but be a driver for it as ammonia is critically involved in regulating myostatin . Sarcopenia is associated with worse outcomes in cirrhosis . Ammonia also impairs neutrophil function, thus predisposing to infection .…”

Section: Discussionmentioning

confidence: 99%

Prognostic Role of Ammonia in Patients With Cirrhosis

et al. 2019

View full text Add to dashboard Cite

Ammonia is thought to be central to the pathogenesis of hepatic encephalopathy (HE), but its prognostic role in patients with cirrhosis and acute decompensation is unknown. The aims of this study were to determine the relationship between ammonia levels and severity of HE and its association with organ dysfunction and short‐term mortality. We identified 498 patients from two institutions as part of prospective observational studies in patients with cirrhosis. Plasma ammonia levels were measured on admission and Chronic Liver Failure‐Sequential Organ Failure Assessment criteria were used to determine the presence of organ failures. The 28‐day patient survival was determined. Receiver operating characteristic analysis was used to identify the cutoff points for ammonia values, and multivariable analysis was performed using the Cox proportional hazard regression model. The 28‐day mortality was 43.4%. Plasma ammonia correlated with severity of HE (P < 0.001), was significantly higher in nonsurvivors (93 [73‐121] versus 67 [55‐89] µmol/L, P < 0.001), and was an independent predictor of 28‐day mortality (hazard ratio, 1.009, P < 0.001). An ammonia level of 79.5 µmol/L had sensitivity of 68.1% and specificity of 67.4% for predicting 28‐day mortality. An ammonia level of ≥79.5 µmol/L was associated with a higher frequency of organ failures (liver [P = 0.004], coagulation [P < 0.001], kidney [P = 0.004], and respiratory [P < 0.001]). Lack of improvement in baseline ammonia at day 5 was associated with high mortality (70.6%). Conclusion: Ammonia level correlates with not only the severity of HE but also the failure of other organs and is an independent risk factor for mortality; lack of improvement in ammonia level is associated with high risk of death, making it an important biomarker and a therapeutic target.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognostic Role of Ammonia in Patients With Cirrhosis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…In fact, BIA tends to overestimate muscle mass in cirrhotic patients . Measurement of the abdominal cross‐sectional muscle area using CT images is a useful method for diagnosing sarcopenia . This CT method is recommended in The Japan Society of Hepatology guidelines for sarcopenia in liver disease …”

Section: Discussionmentioning

confidence: 99%

Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Koya

Kawaguchi

Hashida

et al. 2018

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim Sarcopenia is a prognostic factor in hepatocellular carcinoma (HCC) patients. HCC patients who underwent transcatheter arterial chemoembolization (TACE) are at a risk of muscle atrophy. We aimed to investigate the effects of in‐hospital exercise on muscle mass and factors associated with muscle hypertrophy in HCC patients who underwent TACE. Methods We enrolled 209 HCC patients who underwent TACE. Patients were classified into either an exercise (n = 102) or control (n = 107) group. In the exercise group, patients were treated with in‐hospital exercise (median 2.5 metabolic equivalents/20–40 min/day). The effects of exercise on muscle mass were evaluated by changes in skeletal muscle index (ΔSMI) between before and after TACE. Factors associated with an increase in SMI were analyzed by logistic regression and decision‐tree analyses. Results There was no significant difference in serum albumin and bilirubin levels between the two groups. ΔSMI was significantly higher in the exercise group than in the control group (0.28 cm2/m2 vs −1.11 cm2/m2, P = 0.0029). In the logistic regression analysis, exercise was an independent factor for an increase in SMI (hazard ratio 2.13; 95% confidence interval 1.215–3.846; P = 0.0085). Moreover, the decision‐tree analysis showed that exercise was the initial divergence variable for an increase in SMI (the ratio of increased SMI: 53% in the exercise group vs 36% in the control group). Conclusions In‐hospital exercises increased muscle mass in HCC patients who underwent TACE. In addition, exercise was an independent factor for muscle hypertrophy. Thus, in‐hospital exercise may prevent sarcopenia in HCC patients who underwent TACE.

show abstract

Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Cited by 264 publications

References 57 publications

Prognostic Role of Ammonia in Patients With Cirrhosis

Prognostic Role of Ammonia in Patients 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

Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Contact Info

Product

Resources

About