Muscle depletion in cirrhotic patients assessed using computed tomography
a cross-sectional study
Palavras-chave:
Liver cirrhosis, Sarcopenia, Mortality, MalnutritionResumo
BACKGROUND: Sarcopenia is a common complication in patients with cirrhosis and may lead to increased morbidity and mortality. OBJECTIVE: To investigate the prevalence of sarcopenia and its association with disease severity scores, among patients with cirrhosis. DESIGN AND SETTING: Observational and retrospective cohort study carried out in a tertiary-care hospital in southern Brazil. METHODS: This study was conducted among patients with chronic liver disease who were followed up at the gastroenterology and hepatology outpatient clinic of a tertiary-care hospital in southern Brazil and who underwent computed tomography scans of the abdomen through any indication. RESULTS: We included 83 patients in the study. In the population evaluated, there was a predominance of males (57.80%) and the mean age was 56 years. Hepatitis B or C virus was present in the genesis of the disease in 34.9% of the cases, followed by an etiology of alcohol abuse (30.1%). Sarcopenia was diagnosed in 41 (49.4%) of the patients when the cutoff point for cirrhotic patients was used. There was no significant correlation between the Child-Pugh and MELD severity scores and the occurrence of sarcopenia. CONCLUSION: Sarcopenia presents high prevalence among patients with chronic liver disease without any association with predictors of severity.
Downloads
Referências
Rowe IA. Lessons from Epidemiology: The Burden of Liver Disease. Dig Dis. 2017;35(4):304-9. PMID: 28468017; doi: 10.1159/000456580.
Giannousis IP, Papatheodoridis GV, Deutsch MJ, et al. The burden and recent epidemiological changes of the main chronic liver diseases in a Greek referral tertiary centre. Eur J Gastroenterol Hepatol. 2010;22(2):172-9. PMID: 19738477; doi: 10.1097/MEG.0b013e328331115b.
Ginés P, Quintero E, Arroyo V, et al. Compensated cirrhosis: natural history and prognostic factors. Hepatology. 1987;7(1):122-8. PMID: 3804191; doi: 10.1002/hep.1840070124.
Zatoński WA, Sulkowska U, Mańczuk M, et al. Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe. Eur Addict Res. 2010;16(4):193-201. PMID: 20606444; doi: 10.1159/000317248.
Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086-102. PMID: 17727436; doi: 10.1111/j.1572-0241.2007.01481.x.
Nader LA, de Mattos AA, Bastos GA. Burden of liver disease in Brazil. Liver Int. 2014;34(6):844-9. PMID: 24422599; doi: 10.1111/liv.12470.
Nishikawa H, Osaki Y. Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis. Mediators Inflamm. 2015;2015:872152. PMID: 26494949; doi: 10.1155/2015.872152.
Fernandes SA, Bassani L, Nunes FF, et al. Nutritional assessment in patients with cirrhosis. Arq Gastroenterol. 2012;49(1):19-27. PMID: 22481682.
Nunes FF, Bassani L, Fernandes SA, et al. Food consumption of cirrhotic patients, comparison with the nutritional status and disease staging. Arq Gastroenterol. 2016;53(4):250-6. PMID: 27706455; doi: 10.1590/S0004-28032016000400008.
Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35(3):421-30. PMID: 11592607; doi: 10.1016/s0168-8278(01)00130-1.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease; J Hepatol. 2019;70(1):172-93. PMID: 30144956; doi: 10.1016/j.jhep.2018.0.024.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23. PMID: 20392703; doi: 10.1093/ageing/afq034.
Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059-64. PMID: 17077199; doi: 10.1093/gerona/61.10.1059.
Delmonico MJ, Harris TB, Lee JS, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc. 2007;55(5):769-74. PMID: 17493199; doi: 10.1111/j.1532-5415.2007.01140.x.
Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis--aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther. 2016;43(7):765-77. PMID: 26847265; doi: 10.1111/apt.13549.
Kallwitz ER. Sarcopenia and liver transplant: The relevance of too little muscle mass. World J Gastroenterol. 2015;21(39):10982-93. PMID: 26494955; doi: 10.3748/wjg.v21.i39.10982.
Hanai T, Shiraki M, Nishimura K, et al. Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition. 2015;31(1):193-9. PMID: 25441595; doi: 10.1016/j.nut.2014.07.005.
Giusto M, Lattanzi B, Albanese C, et al. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry. Eur J Gastroenterol Hepatol. 2015;27(3):328-34. MID: 25569567; doi: 10.1097/MEG.0000000000000274.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. PMID: 30312372; doi: 10.1093/ageing/afy169.
Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4):413-21. PMID: 14769646; doi: 10.1093/aje/kwh058.
Shen W, Punyanitya M, Wang Z, et al. Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985). 2004;97(6):2333-8. PMID: 15310748; doi: 10.1152/japplphysiol.00744.2004.
Mourtzakis M, Prado CM, Lieffers JR. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006. PMID: 18923576; doi: 10.1139/H08-075.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646-9. PMID: 4541913; doi: 10.1002/bjs.1800600817.
Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864-71. PMID: 10733541; doi: 10.1053/he.2000.5852.
van Vugt JL, Levolger S, Gharbharan A, et al. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle. 2017;8(2):285-97. PMID: 27897414; doi: 10.1002/jcsm.12158.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl. 2017;23(5):625-33. PMID: 28240805; doi: 10.1002/lt.24750.
Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629-35. PMID: 18539529; doi: 10.1016/S1470-2045(08)70153-0.
Jeong JY, Lim S, Sohn JH, et al. Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis. J Korean Med Sci. 2018;33(50): e299. PMID: 30534029; doi: 10.3346/jkms.2018.33.e299.
Tandon P, Low G, Mourtzakis M, et al. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016;14(10):1473-1480.e3. PMID: 27189915; doi: 10.1016/j.cgh.2016.04.040.
Montano-Loza AJ, Meza-Junco J, Prado CM, et al. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012;10(2):166-73. PMID: 21893129; doi: 10.1016/j.cgh.2011.08.028.
Tandon P, Ney M, Irwin I, et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012;18(10):1209-16. PMID: 22740290; doi: 10.1002/lt.23495.
Meza-Junco J, Montano-Loza AJ, Baracos VE, et al. Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. J Clin Gastroenterol. 2013;47(10):861-70. PMID: 23751844; doi: 10.1097/MCG.0b013e318293a825.
Zambrano DN, Xiao J, Prado CM, Gonzalez MC. Patient-Generated Subjective Global Assessment and Computed Tomography in the assessment of malnutrition and sarcopenia in patients with cirrhosis: Is there any association? Clin Nutr. 2019; pii: S0261-5614(19)30274-2. PMID: 31307841; doi: 10.1016/j.clnu.2019.06.018.
Jones KI, Doleman B, Scott S, Lund JN, Williams JP. Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications. Colorectal Dis. 2015;17(1):O20-6. PMID: 25328119; doi: 10.1111/codi.12805.
Sheean PM, Peterson SJ, Gomez Perez S, et al. The prevalence of sarcopenia in patients with respiratory failure classified as normally nourished using computed tomography and subjective global assessment. JPEN J Parenter Enter Nutr. 2014;38(7):873-9. PMID: 23980135; doi: 10.1177/0148607113500308.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014;20(25):8061-71. PMID: 25009378; doi: 10.3748/wjg.v20.i25.8061.
Montano-Loza AJ, Meza-Junco J, Prado CMM, et al. New cutoff values for sarcopenia for predicting 6-month mortality in cirrhotic patients. J Hepatol. 2013;58:S63-227. doi: 10.1016/S0168-8278(13)60223-8.
Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, et al. Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis. Clin Transl Gastroenterol. 2015;6(7):e102. PMID: 26181291; doi: 10.1038/ctg.2015.31.
Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. PMID: 23530101; doi: 10.1200/JCO.2012.45.2722.
Kim HY, Jang JW. Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score. World J Gastroenterol. 2015;21(25):7637-47. PMID: 23167066; doi: 10.3748/wjg.v21.i25.7637.
Nishikawa H, Kita R, Kimura T, et al. Clinical implication of performance status in patients with hepatocellular carcinoma complicating with cirrhosis. J Cancer. 2015;6(4):394-402. PMID: 25767611; doi: 10.7150/jca.11212.
Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131-40. PMID: 25724366; doi: 10.1016/j.help.2015.02.031.
Downloads
Publicado
Como Citar
Edição
Seção
Licença

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.