The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

Abstract

Background: Sarcopenia and myosteatosis have been associated to a poor prognosis of cirrhosis and to a higher incidence of hepatic encephalopathy (HE). The prognostic implications of visceral and subcutaneous adiposity are less known. Aim:To evaluate the modifications of visceral and subcutaneous adipose tissue after TIPS and to investigate their relationships with the modification of muscle mass and with the incidence of post-TIPS HE. Patients and Methods: 35 cirrhotic patients submitted to TIPS were retrospectively studied. The modification of skeletal muscle index (SMI), muscle attenuation (myosteatosis), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), assessed by CT-scan and plasma ammonia were evaluated before and after a mean follow-up of 19 ± 15 months after TIPS. The number of episodes of overt HE was also recorded.Results: During the follow-up, the mean SMI and muscle attenuation increased significantly; SATI significantly increased while VATI significantly decreased, although not uniformly in all patients. By comparing the patients with or without improvement in their nutritional status after TIPS, MELD remained stable while the number of episodes of overt HE was significantly lower in the patients with improved SMI and in the patients with improved SATI. Finally, inverse correlation was observed between the variation of ammonia and SATI (r = −.40; P < .05). Conclusion:In addition to muscle mass, adipose tissue is modified after TIPS. The improvement of subcutaneous adipose tissue as well as of sarcopenia and myosteatosis is associated to the amelioration of cognitive impairment independently of liver function. The correlation between adipose tissue and ammonia modification may suggest an active role of the adipose tissue in the inter-organ ammonia trafficking.

Hepatic venous pressure gradient (HVPG) predicts liver failure after transjugular intrahepatic portal shunt: a retrospective cohort study

“…HVPG was found to be useful for predicting long-term mortality in patients with decompensated cirrhosis, especially in the presence of ascites ( 27 ), which may be related to acute ischemia of the liver ( 6 ). The applicability of this strategy to patients with less severe liver dysfunction is still a matter of debate ( 40 - 42 ). The TIPS procedure aims to decrease portal pressure gradient (PPG) to just <12 mmHg or at least 20% from baseline levels ( 10 ).…”

Association of myosteatosis with various body composition abnormalities and longer length of hospitalization in patients with decompensated cirrhosis

“…Actually, some pioneers addressed an improvement in various body composition profiles following interventional treatment. Gioia and colleagues found that sarcopenia and myosteatosis greatly improved in response to transjugular intrahepatic portosystemic shunt (TIPS) placement ( 25 ). Intriguingly, SATI significantly increased in addition to the drastic decrement pertaining to VATI, which was relevant to the amelioration of hepatic encephalopathy episodes independent of hepatic function.…”

Dissecting the Contributing Role of Divergent Adipose Tissue to Multidimensional Frailty in Cirrhosis

“…30 Third, Gioia et al found that SAT contributed to handle and reduce ammonia levels, raising its role for ammonia and conversion of glutamate to glutamine by glutamine synthase. 31 Hyperammonemia results in decreased protein synthesis and increased autophagic proteolysis, and consequent sarcopenia is associated with the development of frailty. 32,33 Fourth, the adipose tissue depot is a major organ with microRNA (miRNA), and adipose miRNA profiles corresponding to body composition and functional status and predict adverse clinical outcomes.…”