European Working Group on Sarcopenia in Older People (EWGSOP2) Criteria With Population-Based Skeletal Muscle Index Best Predicts Mortality in Asians With Cirrhosis.
J Clin Exp Hepatol
; 12(1): 52-60, 2022.
Article
em En
| MEDLINE
| ID: mdl-35068785
ABSTRACT
BACKGROUND/AIMS:
Multiple definitions of sarcopenia exist and the acceptable criterion that best predicts outcome is lacking. We estimated the prevalence of sarcopenia based on four criteria and assessed their utility in predicting mortality in cirrhotics.METHODS:
In a prospective observational study, consecutive Asian patients with cirrhosis underwent testing for handgrip strength (HGS) and estimation of skeletal muscle index (SMI) using computed tomography at the third lumbar vertebra. Sarcopenia was defined based on the Western cut-off (WC; SMI < 50 cm2/m2 for men and <39 cm2/m2 for women), Asian cut-off (AC; SMI < 36.5 cm2/m2 for men and 30.2 cm2/m2 for women), European Working Group on Sarcopenia in Older People-2nd meeting (EWGSOP2) definition incorporating low HGS (<27 kg for men and <16 kg for women) with low SMI (defined by the WC), and EWGSOP2 definition with low HGS and low SMI (defined by AC). Risk factors for mortality were assessed using multivariate Cox-proportional hazards.RESULTS:
We included 219 patients with cirrhosis (168 men; mean age 42.6 years) with 50.2% patients having decompensation. Alcohol was the commonest aetiology (33.3%). The prevalence of sarcopenia was highest with the WC (men 82.1%; women 62.7%). There was a weak concordance among all criteria (Fleiss' kappa 0.23, 95% confidence interval [CI] 0.10-0.37). Overall, 12-month survival was 86.1% (81.1-91.3%) over a median (interquartile range) follow-up of 12 (6-15) months. Ascites (hazards ratio [HR] 6.27 [95% CI 1.6-24.1]; P < 0.007) and SMI (HR 0.92 [0.85-0.98]; P = 0.021) were independent predictors of mortality. The 12-month mortality rate was higher in patients with sarcopenia, irrespective of criteria (log rank P < 0.05). Low HGS and low SMI (defined by AC) was the best for predicting mortality (HR 3.04 [1.43-6.43]; P = 0.004).CONCLUSION:
A weak concordance exists amongst various diagnostic definitions of sarcopenia. Sarcopenia diagnosed by a combination of low HGS and population-specific SMI cut-off (AC) best predicts mortality.
6MWD, 6-min walk distance; AC, Asian cut-off; ACLF, acute on chronic liver failure; BMI, body mass index; CI, confidence interval; CT, computed tomography; CTP, Child-Turcotte-Pugh; EWGSOP2; EWGSOP2, European Working Group on Sarcopenia in Older People2nd meeting; HCC, hepatocellular cancer; HE, hepatic encephalopathy; HGS, handgrip strength; HR, hazards ratio; HU, Hounsfield unit; IQR, interquartile range; LT, liver transplant; MELD, model for end-stage liver disease; SD, standard deviation; SMA, skeletal muscle area; SMI, skeletal muscle index; WC, Western cut-off; sarcopenia; skeletal muscle index
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Base de dados:
MEDLINE
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
J Clin Exp Hepatol
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Índia