Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis

Abstract

BACKGROUND: Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cut-off values are missing and most studies used computed tomography (CT). This study evaluated fat-free muscle area as a marker of sarcopenia using magnetic resonance imaging (MRI) in decompensated cirrhotic patients with transjugular intrahepatic portosystemic shunt (TIPS).

METHODS: The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the fat-free muscle area (FFMA) in 116 cirrhotic patients with TIPS and MRI. The training cohort of 71 patients compared CT-measured transversal psoas muscle thickness (TPMT) with FFMA. In 15 patients, MRI was performed before and after TIPS, and in 12 patients, follistatin serum measurements were carried out. The results on FFMA were confirmed in a validation cohort of 45 patients.

RESULTS: FFMA correlated with follistatin and TPMT and showed slightly better association with survival than TPMT. Gender-specific cut-off values for FFMA were determined for sarcopenia. Decompensation (ascites, overt hepatic encephalopathy) persisted after TIPS in the sarcopenia group but resolved in the non-sarcopenia group. Sarcopenic patients showed no clinical improvement after TIPS as well as higher mortality, mainly due to development of acute-on-chronic liver failure (ACLF). FFMA was an independent predictor of survival in these patients.

CONCLUSION: This study offers an easy to apply MRI-based measurement of fat-free muscle mass as a marker of sarcopenia in decompensated patients. While TIPS might improve sarcopenia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of ACLF development and mortality. This article is protected by copyright. All rights reserved.

http://ift.tt/2z2GU6s