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Liver Transpl. 2017 May;23(5):625-633. doi: 10.1002/lt.24750.

A multicenter study to define sarcopenia in patients with end-stage liver disease.

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, Phoenix, AZ.
2
Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA.
3
Division of Internal Medicine, University of California, San Francisco, San Francisco, CA.
4
Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.
5
Division of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
6
Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
7
Center for Liver Diseases, Liver Research Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.

Abstract

Sarcopenia is associated with increased wait-list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross-sectional area (cm2 ) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait-list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex-specific potential cutoff values to define sarcopenia were determined with a grid search guided by log-rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2 /m2 : 50.0 in men and 42.0 in women. At a median of 8.8 months follow-up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2 /m2 ; P < 0.001), and SMI was associated with wait-list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2 /m2 for men and 39 cm2 /m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2 /m2 for men and < 39 cm2 /m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625-633 2017 AASLD.

PMID:
28240805
PMCID:
PMC5762612
DOI:
10.1002/lt.24750
[Indexed for MEDLINE]
Free PMC Article

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