Loss of paraspinal muscle mass is a gender-specific consequence of cirrhosis that predicts complications and death
Funding
Cornelius Engelmann is funded by the German Research Foundation (DFG) (EN 1100/2-1). He has an on-going research collaboration with Sequana Medical, Merz Pharmaceutical and Novartis. He received speaker fees from Novartis. Thomas Berg received: Research support from Abbvie, Roche, BMS, Gilead, Novartis, Merck/MSD, Intercept, Janssen, Novartis, Sequana Medical, and Pfizer; provided consultancy, speakers bureau and participated in advisory boards for Abbvie, Alexion, Bayer, Boehringer Ingelheim, BMS, Gilead, GSK, Intercept, Janssen, MSD/Merck, Merz, Novartis, Sequana Medical and Roche. All other authors declared no funding interests.
Summary
Background
Loss of skeletal muscle mass is a recognised complication with a prognostic impact in patients with cirrhosis.
Aim
To explore in a retrospective analysis which muscle compartment most reliably predicts the occurrence of cirrhosis-associated complications and if there are gender-related differences.
Methods
795 patients with cirrhosis listed for liver transplantation between 2001 and 2014 met the inclusion and exclusion criteria including an abdominal CT scan (±200). Controls were 109 patients who underwent a CT scan after polytrauma. The paraspinal muscles index (PSMI), the abdominal wall muscles index (AWMI) and its combination skeletal muscle index (SMI) were assessed at L3/L4, normalised to the height (cm2/m2).
Results
62.0% of patients with cirrhosis had alcoholic liver disease, and 70.6% were male. As compared to controls, a reduction in PSMI and SMI but not AWMI was associated with high model of end-stage liver disease (MELD) score, high Child-Pugh class, and the presence or history of cirrhosis-associated complications in males but not females. PSMI independently predicted the occurrence of bacterial infections (HR 0.932), spontaneous bacterial peritonitis (HR 0.901), hepatic encephalopathy (HR 0.961), and hepatorenal syndrome (HR 0.946) by multivariate Cox regression analysis in a gender-independent manner. Post-transplant survival was not associated with the PSMI; neither AWMI nor SMI predicted any clinical endpoints.
Conclusions
This study links muscle wasting in patients with cirrhosis predominantly to males. However, the presence of a low PSMI mass is a gender-independent predictor of developing cirrhosis-associated complications and death. Scores combining the MELD with muscle parameters should be re-validated by utilizing the PSMI.
