Elliot B Tapper1,2, Brian Derstine3, Jad Baki4, Grace L Su5,6. 1. Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman, SPC 5362, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA. etapper@umich.edu. 2. Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. etapper@umich.edu. 3. Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA. 4. University of Michigan, Ann Arbor, MI, USA. 5. Division of Gastroenterology and Hepatology, University of Michigan, 3912 Taubman, SPC 5362, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA. 6. Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Frailty and sarcopenia are associated with mortality and poor outcomes among patients with cirrhosis. Frailty is multifactorial but due in part to sarcopenia and cognitive dysfunction. Data are limited regarding the correlation of bedside frailty and cognitive function measures with sarcopenia. AIMS: To evaluate the correlations between frailty measures and muscle indices from computed tomography (CT). METHODS: We prospectively enrolled 106 patients with clinically compensated cirrhosis (and no prior hepatic encephalopathy). All patients underwent CT scan and cognitive testing (via inhibitory control test, ICT), and were subject to hand grip, 30-s chair stands, mid-arm muscle area (MAMA), and a four-question algorithm based on the Sickness Impact Profile (SIP) predictive of minimal HE. We evaluated Spearman correlations between all measures as well as the sensitivity and specificity of each measure for falls. RESULTS: In total, 106 (35.3%) patients (55 men) had CT scans to measure skeletal muscle area and quality. Hand grip correlated strongly with skeletal muscle area (correlation coefficient 0.64, p < 0.001) and mildly with ICT performance (0.34, p = 0.002). However, for women, the strongest correlation with hand grip was ICT performance (0.60, p < 0.001). Chair stand performance correlated best with SIP (correlation coefficient - 0.35, p < 0.001). MAMA was not correlated with CT-based muscle indices among women but was for men. Poor chair stand performance (< 10/30-s) had a sensitivity/specificity for falls of 73%/54%; low muscle radiation attenuation (density) was 40%/80% sensitive/specific. CONCLUSION: Bedside measures of physical function, muscle bulk, and cognitive performance are correlated with CT-based muscle measures. Bedside measures of frailty may provide an advantage over sarcopenia for outcome assessment that should be confirmed prospectively.
BACKGROUND: Frailty and sarcopenia are associated with mortality and poor outcomes among patients with cirrhosis. Frailty is multifactorial but due in part to sarcopenia and cognitive dysfunction. Data are limited regarding the correlation of bedside frailty and cognitive function measures with sarcopenia. AIMS: To evaluate the correlations between frailty measures and muscle indices from computed tomography (CT). METHODS: We prospectively enrolled 106 patients with clinically compensated cirrhosis (and no prior hepatic encephalopathy). All patients underwent CT scan and cognitive testing (via inhibitory control test, ICT), and were subject to hand grip, 30-s chair stands, mid-arm muscle area (MAMA), and a four-question algorithm based on the Sickness Impact Profile (SIP) predictive of minimal HE. We evaluated Spearman correlations between all measures as well as the sensitivity and specificity of each measure for falls. RESULTS: In total, 106 (35.3%) patients (55 men) had CT scans to measure skeletal muscle area and quality. Hand grip correlated strongly with skeletal muscle area (correlation coefficient 0.64, p < 0.001) and mildly with ICT performance (0.34, p = 0.002). However, for women, the strongest correlation with hand grip was ICT performance (0.60, p < 0.001). Chair stand performance correlated best with SIP (correlation coefficient - 0.35, p < 0.001). MAMA was not correlated with CT-based muscle indices among women but was for men. Poor chair stand performance (< 10/30-s) had a sensitivity/specificity for falls of 73%/54%; low muscle radiation attenuation (density) was 40%/80% sensitive/specific. CONCLUSION: Bedside measures of physical function, muscle bulk, and cognitive performance are correlated with CT-based muscle measures. Bedside measures of frailty may provide an advantage over sarcopenia for outcome assessment that should be confirmed prospectively.
Authors: Jennifer C Lai; Christopher J Sonnenday; Elliot B Tapper; Andres Duarte-Rojo; Michael A Dunn; William Bernal; Elizabeth J Carey; Srinivasan Dasarathy; Binita M Kamath; Matthew R Kappus; Aldo J Montano-Loza; Shunji Nagai; Puneeta Tandon Journal: Am J Transplant Date: 2019-05-08 Impact factor: 8.086
Authors: Marina Serper; Sunny Y Tao; Dorothea S Kent; Patrik Garren; Alexander E Burdzy; Jennifer C Lai; Amir Gougol; Pamela M Bloomer; K Rajender Reddy; Michael A Dunn; Andres Duarte-Rojo Journal: Liver Transpl Date: 2021-08-01 Impact factor: 5.799
Authors: Jennifer C Lai; Puneeta Tandon; William Bernal; Elliot B Tapper; Udeme Ekong; Srinivasan Dasarathy; Elizabeth J Carey Journal: Hepatology Date: 2021-09 Impact factor: 17.298
Authors: Elliot B Tapper; Lilli Zhao; Samantha Nikirk; Jad Baki; Neehar D Parikh; Anna S Lok; Akbar K Waljee Journal: Am J Gastroenterol Date: 2020-12 Impact factor: 12.045
Authors: Wolfgang M Kremer; Michael Nagel; Michael Reuter; Max Hilscher; Maurice Michel; Leonard Kaps; Joachim Labenz; Peter R Galle; Martin F Sprinzl; Marcus-Alexander Wörns; Christian Labenz Journal: Clin Transl Gastroenterol Date: 2020-07 Impact factor: 4.396