Sarcopenia defined with L3-SMI is an independent predictor of survival in male patients with ARLD in mainland China.

Background: The burden of alcohol-related liver disease (ARLD) is increasing in China. Patients with ARLD are more likely to have comorbid sarcopenia, which may impair their survival. This study aimed to evaluate the relationship between the prognoses of patients with ARLD and sarcopenia, identified using the skeletal muscle index at the third lumbar vertebra level (L3-SMI). Methods: Hospitalized patients with ARLD were retrospectively enrolled between 2015 and 2018 and followed up for 24 months to evaluate their survival profiles. Cox proportional hazards regression models were used to estimate patient survival factors. A receiver operating characteristic curve was created to identify the cut-off point of the L3-SMI for predicting the prognoses of Chinese patients with ARLD. Results: The study enrolled 168 male patients with ARLD who were followed-up for 24 months or until a study endpoint was met. The overall L3-SMI in patients with ARLD was 42.61 ± 9.15 cm2/m2, and 42.86% (72/168) of patients with ARLD were comorbid with sarcopenia. The overall survival in patients with ARLD was 77.38% at 24 months. The survival rate of patients with sarcopenia was lower than that of patients without sarcopenia (66.67% vs. 85.42%, p = 0.004). Multiple Cox regression analysis showed that sarcopenia, abstinence, and baseline creatinine level were independent prognostic factors of 24-month survival with hazard ratios (95% confidence intervals) of 2.022 (1.025-3.991), 0.275 (0.122-0.617), and 1.018 (1.008-1.027), respectively. The cut-off value of the L3-SMI for predicting 24-month survival was 40.0 cm2/m2 for male patients with ARLD. Conclusion: Sarcopenia is an independent mortality risk factor in male patients with ARLD in mainland China. Early diagnosis and intervention of sarcopenia are important for optimizing the management of patients with ARLD.

Myelosuppression Caused by Nanoparticle Albumin-Bound Paclitaxel in the Northern Chinese Population and the Role of Body Composition.

The aim of this study was to examine the relationship between lean body mass (LBM) and the incidence and severity of neutropenia in patients with malignant tumors from Northern China who have received nanoparticle albumin-bound paclitaxel. Twenty-six patients with pathologically confirmed malignant tumors were prospectively included in this study. These 26 patients were divided into Group A (sarcopenia) and Group B (nonsarcopenia). Group A comprised 50% (13/26) of the patients, while Group B comprised the other 50% (13/26). There was no statistically significant difference between both groups in terms of body surface area (P = .052). The incidence of neutropenia in Group A was 76.9% compared to 61.5% in Group B (P = .0673). The incidence of Grade 3 and severe neutropenia was 76.9% versus 61.5% in Groups A and B, respectively (P = .645). These 26 patients were divided into Groups 1 and 2 based on the administered nab-paclitaxel dose per kilogram of LBM, with both groups receiving a body surface area dose of 260 mg/m2 . Group 1 received a nab-paclitaxel dose of 14.19 mg/kg of LBM, whereas Group 2 received 11.37 mg/kg of LBM. In Group 1, the incidence of neutropenia was 71.4%, whereas it was 66.7% in Group 2. Grade 3 or higher neutropenia incidence was 28.6% in Group 1 versus 16.7% in Group 2. Patients with sarcopenia in northern China experienced a higher incidence of severe neutropenia after receiving nab-paclitaxel than patients without sarcopenia. Higher drug dose intensity per unit of LBM may be a contributing factor.

Psoas Muscle Index: A Simple and Reliable Method of Sarcopenia Assessment on Computed Tomography Scan in Chronic Liver Disease and its Impact on Mortality.

Objectives: Psoas muscle parameters have been proposed as a simple and quick method for sarcopenia assessment. The aim of this study was to assess sarcopenia in cirrhotics by psoas muscle on computed tomography and its impact on mortality. Methods: One hundred and fifty patients (75 cirrhotics, 75 subjects) were assessed for psoas muscle on CT scan. Psoas muscle index (PMI) was calculated as 'total psoas muscle area/(height of subject)2'. Cut off values for sarcopenia diagnosis were derived from local subjects (n = 75) who did not have cirrhosis/other causes of sarcopenia. Results: Sarcopenia assessed by PMI was seen in 36% (n = 27) of the cirrhotics. Sarcopenia was significantly higher in patients having Child-Pugh C. Ascites, hepatic encephalopathy (HE) and gastro-intestinal bleed were seen in 48%, 18.7% and 24%, respectively. Sarcopenia was significantly associated with ascites and HE (P < 0.05). Out of the 75 cases, 53 cases completed the follow-up period of 1 year. Among the 20 cases who had sarcopenia, 35% (n = 7) succumbed to liver-related illness during 1 year follow-up, and out of the 33 cases without sarcopenia, only 6% (n = 2) died. The association of sarcopenia and 1 year mortality was statistically significant (P = 0.01). Conclusions: The PMI, a simple method for sarcopenia assessment detected sarcopenia in 36% of cirrhotics. Patients with sarcopenia had a significantly higher 1 year mortality rate and appropriate prognostication of such patients is needed.

Sarcopenia as Manifested by L3SMI Is Associated with Increased Long-Term Mortality amongst Internal Medicine Patients-A Prospective Cohort Study.

Background: Sarcopenia and Frailty are syndromes that affect the clinical outcomes of patients suffering from a wide range of diseases. The use of Computed Tomography (CT) is well established for Sarcopenia evaluation via estimation of the Skeletal Muscle Index (SMI) at the level of the third lumbar vertebra (L3SMI). Nevertheless, the association of more readily available biomarkers of Sarcopenia and clinical outcomes is desired. Recent studies have associated low Alanine amino-transferase ALT (SGPT) levels with Sarcopenia and frailty. The current study aimed to establish the association between low L3SMI and the aforementioned indices of Sarcopenia, frailty and poor clinical outcomes. Methods: A cohort study of patients admitted to the internal medicine department at a tertiary medical center. Sarcopenia was determined as L3SMI, lower than 53 cm2/m2 in men and 41 cm2/m2 in women. Clinical and mortality data was collected from the medical record. Results: Of the 187 patients recruited (mean age 70.4 ± 9.2, 59% males), 116 (62%) had Sarcopenia, based on L3SMI values. Sarcopenic patients were older, predominantly male, had lower BMI, lower mid-arm muscle circumference (MAMC) and low ALT values upon admission. L3SMI values significantly correlated with age and MAMC among males (R = −0.38, p < 0.001, R = 0.35, p < 0.001, respectively). Sarcopenia was associated with higher, one-year mortality (HR = 2.60, 95% CI 1.06−6.37, p = 0.036) and shorter all-time survival (HR = 2.91, 95% CI 1.35−6.29, p = 0.007). The association with all-time survival remained after adjusting for age and sex (HR = 2.38, 95% CI 1.07−5.29, p = 0.034). Conclusion: As defined by low L3SMI value, Sarcopenia is a poor prognostic factor for the general internal ward patient population. As part of personalized medicine, physicians may benefit from measuring L3SMI value, as indicated by commonly performed CT scans, to objectively assess their patient's risk of suffering from Sarcopenia and frailty-associated complications.

Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction.

Background & Aims: We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predicting PVR failure and stent occlusion. Methods: This retrospective monocentric study included all patients who underwent PVR without TIPS insertion in the context of CNC-EHPVO between the years 2000 and 2019. Primary patency was defined by the absence of a complete stent occlusion on follow-up imaging. Results: A total of 31 patients underwent PVR with a median follow-up of 52 months (24-82 months). Indications were gastrointestinal bleeding (n = 13), abdominal pain attributed to CNC-EHPVO (n = 7), prior to abdominal surgery (n = 4), and others (n = 7). Technical success was obtained in 27 patients. PVR failure was associated with extension within the intrahepatic portal veins (p = 0.005) and recanalisation for abdominal pain (p = 0.02). Adverse events occurred in 6 patients with no mortality. Anticoagulation was administered in 21 patients after technical success of PVR. In patients with technical success, 5-year primary patency was 73% and was associated with improved muscle mass (p = 0.007) and decreased spleen volume (p = 0.01) at 1 year. Furthermore, 21 (78%) patients with PVR technical success were free of portal hypertension complication at 5 years. Conclusions: PVR without TIPS insertion was feasible and safe in selected patients with CNC-EHPVO and portal hypertension with past or expected complications. Primary patency at 5 years was obtained in 3 of 4 patients with technical success of PVR and was associated with a control of complications of CNC-EHPVO. PVR was associated with improvement of sarcopenia and decreased spleen volume at 1 year. Lay summary: Patients with chronic obstruction of the portal vein and without cirrhosis or malignancy can develop complications related to the high pressure in the venous system. The present study reports long-term favourable outcome of patients in whom the obstruction was treated with stents.

Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients.

Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

Correlation between L3 skeletal muscle index and prognosis of patients with stage IV gastric cancer.

BACKGROUND: To explore the relationship between L3 skeletal muscle index (SMI) and the prognosis of patients with stage IV gastric cancer (GC). METHODS: A total of 27 patients with stage IV GC requiring chemotherapy admitted to our hospital from 1 April 2015 to 20 May 2019 were selected as participants. The Kaplan-Meier method was used to describe the survival time of all participants. By evaluating the L3 plane CT images, the mass index (cm2/m2) of L3 skeletal muscle (including psoas major, erector spinae, quadratus psoas, transversus abdominis, external oblique abdominis, and internal oblique abdominis) was calculated to study the changes of L3 SMI during treatment and the correlation between L3 SMI and clinical features. The log-rank method was used to analyze the correlativity between the survival time of patients and their general data, L3 SMI, or other indicators. RESULTS: The survival time of 27 patients with stage IV GC was 7.4-49.9 months, with a mean survival time of 19.72 months and a median survival time of 16.17 months. The 1-year survival rate was 77.78%, and the 3-year survival rate was 7.41%. During treatment, L3 SMI continued to decline in 20 of the 27 participants (74.07%). After the first chemotherapy, 17 participants (62.96%) met the criteria of sarcopenia syndrome, and after the fourth chemotherapy, 19 participants (70.37%) met the criteria of sarcopenia syndrome. The L3 SMI was shown to be significantly correlated with body mass index (BMI) and Onodera's prognostic nutritional index (OPNI) (both P<0.05), but not with age, gender, dietary intake, and primary site (all P>0.05). Log-rank test showed that there was a correlation between L3 SMI and survival time of patients (P<0.05). The average survival time of participants with sarcopenia syndrome (16.78 months) was significantly lower than that of those without sarcopenia syndrome (25.58 months) (P<0.05). CONCLUSIONS: There is a significant correlation between L3 SMI and survival time, and L3 SMI can be used as a potential index to evaluate the prognosis of patients with stage IV GC.