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Muscle volume loss correlated with increased mortality in cirrhosis

Among patients with cirrhosis, muscle volume loss and hepatocellular carcinoma within Milan criteria were prognostic factors for mortality, according to recently published data.

As many patients with cirrhosis have protein-calorie malnutrition, the researchers advise that improving protein catabolism and lipolysis with a “late night snack” and combined in-hospital exercise with consumption of branched chain amino acids can minimize skeletal muscle atrophy.

“Recent progress in anti-viral therapy, such as direct-acting antivirals, and nucleos(t)ide analogues, has made prevention of [chronic liver disease (CLD)] progression possible, though issues related to muscle wasting in CLD patients remain,” the researchers wrote. “Establishment of an effective strategy for treating progression of [muscle volume loss] and reduced muscle strength in CLD patients will be needed.”

The researchers enrolled 346 patients with cirrhosis who underwent upper gastrointestinal endoscopy and CT. Researchers matched 1:1 patients with portal hypertension (PHT) and those without according to age, sex, and clinical demographics.

Patients with muscle volume loss in the PHT group had a significantly lower rate of overall survival compared with patients without muscle loss in both the PHT group (P = .017) and the group without PHT (P = .012).

Overall, patients with muscle volume loss had lower 1-year (89.1% vs. 98.1%; P < .001), 3-year (69% vs. 98.1%; P < .001) and 5-year (35.8% vs. 74.1%; P < .001) survival rates than those without muscle volume loss. This remained significant after the researchers excluded patients with HCC at 1 year (85.9% vs 98.9; P < .0014), 3 years (72.8% vs. 93.5%; P < .0014) and 5 years (72.8% vs. 86.4%; P = .0014).

After multivariate analysis, muscle volume loss (HR = 2.797; 95% CI, 1.601-4.885) and HCC within Milan criteria (HR = 2.028; 95% CI, 1.189-3.46) predicted worse mortality outcomes.

“Although the cause of death in patients without [muscle volume loss] was digestive bleeding in three and unknown in five, the frequency of death from other organ complications was greater in those with [muscle volume loss],” the researchers concluded. “Additional analyses will be needed to elucidate the role of [muscle volume loss] in the clinical course of CLD patients, especially those with PHT.” – by Talitha Bennett

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