Xinxing Tantai1, Yi Liu2, Yee Hui Yeo3, Michael Praktiknjo4, Ezequiel Mauro5, Yuhei Hamaguchi6, Cornelius Engelmann7, Peng Zhang8, Jae Yoon Jeong9, Jeroen Laurens Ad van Vugt10, Huijuan Xiao11, Huan Deng12, Xu Gao13, Qing Ye14, Jiayuan Zhang15, Longbao Yang1, Yaqin Cai1, Yixin Liu1, Na Liu1, Zongfang Li16, Tao Han14, Toshimi Kaido17, Joo Hyun Sohn18, Christian Strassburg4, Thomas Berg19, Jonel Trebicka20, Yao-Chun Hsu21, Jan Nicolaas Maria IJzermans10, Jinhai Wang22, Grace L Su23, Fanpu Ji24, Mindie H Nguyen25. 1. Department of Gastroenterology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China. 2. Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China. 3. Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: yeehui.yeo@cshs.org. 4. Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany. 5. Liver Transplant Unit, Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina. 6. Department of Gastrointestinal Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan. 7. Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany; Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Institute for Liver and Digestive Health, University College London, London, UK. 8. Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, MI, USA. 9. Department of Gastroenterology and Hepatology, National Medical Center, Seoul, South Korea. 10. Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC University Medical Centre, Rotterdam, Netherlands. 11. Department of Nutrition, The Third Central Hospital of Tianjin, Tianjin, China. 12. National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China. 13. Department of Gastroenterology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China. 14. Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, PR China. 15. Xi'an Jiaotong University Library, Xi'an, PR China. 16. National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, PR China. 17. Department of Gastroenterological and General Surgery, St Luke's International Hospital, Tokyo, Japan. 18. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea. 19. Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany. 20. Department of Internal Medicine I, Goethe University Clinic Frankfurt, Germany; European Foundation for Study of Chronic Liver Failure, Barcelona, Spain; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Institute of Bioengineering Catalunya, Barcelona, Spain. 21. Center for Liver Diseases, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan; Division of Gastroenterology and Hepatology, Fu Jen Catholic University Hospital, New Taipei, Taiwan. 22. Department of Gastroenterology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China. Electronic address: jinhaiwang@hotmail.com. 23. Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, MI, USA; Medicine Service VA Ann Arbor Healthcare System, Ann Arbor, Michigan, MI, USA. 24. Department of Infectious Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, PR China. Electronic address: jifanpu1979@163.com. 25. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, United States.
Abstract
BACKGROUND & AIMS: The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, we aimed to quantify the association between sarcopenia and the risk of mortality in patients with cirrhosis, stratified by sex, underlying liver disease etiology, and severity of hepatic dysfunction. METHODS: PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restriction through 13 January 2021 with an additional manual search of bibliographies of relevant articles. Cohort studies of ≥100 patients with cirrhosis and ≥12 months of follow-up that evaluated the association between sarcopenia, muscle mass and the risk of mortality were included. RESULTS: Twenty-two studies involving 6,965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% CI 32.4%-42.8%), and was higher in male patients, those with alcohol-associated liver disease, those with Child-Pugh grade C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index). Sarcopenia was associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratio [aHR] 2.30, 95% CI 2.01-2.63), with similar findings in a sensitivity analysis of patients with cirrhosis without hepatocellular carcinoma (aHR 2.35, 95% CI 1.95-2.83) and in subgroups stratified by sex, liver disease etiology, and severity of hepatic dysfunction. The association between quantitative muscle mass index and mortality further supports the association between sarcopenia and poor prognosis (aHR 0.95, 95% CI 0.93-0.98). There was no significant heterogeneity in any of our analyses. CONCLUSIONS: Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis. LAY SUMMARY: The prevalence of sarcopenia and its association with death in patients with cirrhosis remain unclear. This meta-analysis indicated that sarcopenia affected about one-third of patients with cirrhosis and up to 50% of patients with alcohol-related liver disease or Child-Pugh class C cirrhosis. Sarcopenia was independently associated with an ∼2-fold higher risk of mortality in patients with cirrhosis. The mortality rate increased with greater severity or longer durations of sarcopenia. Increasing awareness about the importance of sarcopenia in patients with cirrhosis among stakeholders must be prioritized.
BACKGROUND & AIMS: The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, we aimed to quantify the association between sarcopenia and the risk of mortality in patients with cirrhosis, stratified by sex, underlying liver disease etiology, and severity of hepatic dysfunction. METHODS: PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restriction through 13 January 2021 with an additional manual search of bibliographies of relevant articles. Cohort studies of ≥100 patients with cirrhosis and ≥12 months of follow-up that evaluated the association between sarcopenia, muscle mass and the risk of mortality were included. RESULTS: Twenty-two studies involving 6,965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% CI 32.4%-42.8%), and was higher in male patients, those with alcohol-associated liver disease, those with Child-Pugh grade C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index). Sarcopenia was associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratio [aHR] 2.30, 95% CI 2.01-2.63), with similar findings in a sensitivity analysis of patients with cirrhosis without hepatocellular carcinoma (aHR 2.35, 95% CI 1.95-2.83) and in subgroups stratified by sex, liver disease etiology, and severity of hepatic dysfunction. The association between quantitative muscle mass index and mortality further supports the association between sarcopenia and poor prognosis (aHR 0.95, 95% CI 0.93-0.98). There was no significant heterogeneity in any of our analyses. CONCLUSIONS: Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis. LAY SUMMARY: The prevalence of sarcopenia and its association with death in patients with cirrhosis remain unclear. This meta-analysis indicated that sarcopenia affected about one-third of patients with cirrhosis and up to 50% of patients with alcohol-related liver disease or Child-Pugh class C cirrhosis. Sarcopenia was independently associated with an ∼2-fold higher risk of mortality in patients with cirrhosis. The mortality rate increased with greater severity or longer durations of sarcopenia. Increasing awareness about the importance of sarcopenia in patients with cirrhosis among stakeholders must be prioritized.
Authors: Mohammad Shafi Kuchay; José Ignacio Martínez-Montoro; José Carlos Fernández-García; Bruno Ramos-Molina; Camilo Julio Llamoza-Torres Journal: Hepatobiliary Surg Nutr Date: 2022-10 Impact factor: 8.265
Authors: Hong Peng; Qian Zhang; Lei Luo; Siyi Lei; Tingting Xiong; Li Long; Yan Xiong; Liulu Zhang; Jinding Zheng; Xinhua Luo Journal: Hepatol Int Date: 2022-06-30 Impact factor: 9.029