Transjugular intrahepatic portosystemic shunt insertion improves muscle mass but not muscle function or frailty measures.
Eur J Gastroenterol Hepatol
; 35(9): 997-1003, 2023 09 01.
Article
em En
| MEDLINE
| ID: mdl-37395688
ABSTRACT
INTRODUCTION:
Sarcopenia in cirrhosis is associated with poor outcomes. While transjugular intrahepatic portosystemic shunt (TIPS) insertion improves radiological measures of muscle mass, its impact on muscle function, performance and frailty has not been evaluated.METHODS:
Patients with cirrhosis referred for TIPS were prospectively recruited and followed for 6 months. L3 CT scans were used to calculate skeletal muscle and adipose tissue parameters. Handgrip strength, Liver Frailty Index and short physical performance battery were serially monitored. Dietary intake, insulin resistance, insulin-like growth factor (IGF)-1, and immune function using QuantiFERON Monitor (QFM) were measured.RESULTS:
Twelve patients completed the study with a mean age of 58â ±â 9 years and model for end-stage liver disease score of 16â ±â 5. At 6 months post-TIPS, skeletal muscle area increased from 139.33 cm 2 â ±â 22.72 to 154.64â ±â 27.42 ( P â =â 0.012). Significant increases were observed in the subcutaneous fat area ( P â =â 0.0076) and intermuscular adipose tissue ( P â =â 0.041), but not muscle attenuation or visceral fat. Despite marked changes in muscle mass, no improvements were observed in handgrip strength, frailty, or physical performance. At 6 months post-TIPS, IGF-1 ( P â =â 0.0076) and QFM ( P â =â 0.006) increased compared to baseline. Nutritional intake, hepatic encephalopathy measures, insulin resistance and liver biochemistry were not significantly impacted.CONCLUSION:
Muscle mass increased following TIPS insertion as did IGF-1, a known driver of muscle anabolism. The lack of improvement in muscle function was unexpected and may relate to impairment in muscle quality and the effects of hyperammonaemia on muscle contractile function. Improvements in QFM, a marker of immune function, may suggest a reduction in infection susceptibility in this at-risk population and requires further evaluation.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Resistência à Insulina
/
Encefalopatia Hepática
/
Derivação Portossistêmica Transjugular Intra-Hepática
/
Doença Hepática Terminal
/
Fragilidade
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
/
Middle aged
Idioma:
En
Revista:
Eur J Gastroenterol Hepatol
Ano de publicação:
2023
Tipo de documento:
Article