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CN 22-1108/R
Volume 41 Issue 4
Apr.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(4): 698-702

Value of third lumbar skeletal muscle mass index in predicting the prognosis of patients with acute-on-chronic liver failure

DOI: 10.12449/JCH250415
  • 1.

    Department of General Surgery，Taiyuan People’s Hospital，Taiyuan 030012，China

  • 2.

    Department of Gastroenterology，Shanxi Bethune Hospital，Taiyuan 030032，China

  • 3.

    Department of Infectious Diseases，The Third People’s Hospital of Henan Province，Zhengzhou 450000，China

Research funding:

Shanxi Province Basic Research Program (202103021224341);

Shanxi Province Basic Research Program (202203021222342);

Shanxi Province Basic Research Program (202303021212328);

Shanxi Provincial Healthy Commission Guiding Science and Technology Project (2021XM42);

Endocrine and Metabolic Diseases Key Laboratory of Shanxi Province (202104010910009)

More Information
  • Corresponding author: WANG Juan， 2647146563@qq.com （ORCID： 0000-0002-0406-8585）
  • Received Date: 2024-08-19
  • Accepted Date: 2024-10-15
  • Published Date: 2025-04-25
    Abstract
  •   Objective  To investigate the value of third lumbar skeletal muscle mass index （L3-SMI） in predicting the long-term prognosis of patients with acute-on-chronic liver failure （ACLF）， and to provide a useful tool for prognostic scoring of ACLF patients.  Methods  A retrospective analysis was performed for the data of 126 patients who underwent abdominal computed tomography （CT） scanning and were diagnosed with ACLF in Shanxi Bethune Hospital from December 2017 to December 2021， including clinical indicators， biochemical parameters， and model for end-stage liver disease （MELD） score， and L3-SMI was calculated. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups； the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic （ROC） curve was used to assess the diagnostic value of L3-SMI and other variables （MELD score and Child-Pugh score）， and the DeLong test was used for comparison of the area under the ROC curve （AUC）.  Results  Among the 126 patients enrolled， 44 （35%） died within 2 years and 82 （65%） survived. Compared with the survival group， the death group had significantly higher age， incidence rate of ascites， international normalized ratio， MELD score， and Child-Pugh score （all P<0.05） and a significantly lower value of L3-SMI ［38.40 （35.95‍ ‍—‍ ‍46.29） cm²/m² vs 44.19 （40.20‍ ‍—‍ ‍48.58） cm²/m²， Z=-2.855， P=0.004］. L3-SMI had an AUC of 0.720 in predicting 2-year mortality in ACLF patients， with a sensitivity of 63.6% and a specificity of 80.5%， and a combination of L3-SMI， MELD score， and Child-Pugh score had a significantly better AUC than a combination of MELD score and Child-Pugh score in predicting 2-year mortality （0.809 vs 0.757， Z=2.015， P<0.05）.  Conclusion  L3-SMI has a high predictive value for the prognosis of ACLF patients， and the combination of L3-SMI、MELD score and Child-Pugh score has a higher predictive value for ACLF patients， and the inclusion of L3-SMI or sarcopenia in the conventional prognostic scores of ACLF patients may increase the ability to predict disease progression.

     

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    • References(25)
  • [1]
    HERNAEZ R, KRAMER JR, LIU Y, et al. Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA[J]. J Hepatol, 2019, 70( 4): 639- 647. DOI: 10.1016/j.jhep.2018.12.018.
    [2]
    ZHANG B, DILIHUMAER ZYE, ZHANG SY, et al. Progress on pathogenesis and medical treatment of hepatitis B virus-related chronic and acute liver failure[J/CD]. Chin J Liver Dis(Electronic Version), 2023, 15( 1): 28- 33. DOI: 10.3969/j.issn.1674-7380.2023.01.005.

    张斌, 迪丽胡玛尔·扎依尔, 张诗雨, 等. 乙型肝炎相关慢加急性肝衰竭发病机制及治疗进展[J/CD]. 中国肝脏病杂志(电子版), 2023, 15( 1): 28- 33. DOI: 10.3969/j.issn.1674-7380.2023.01.005.
    [3]
    ABDALLAH MA, KUO YF, ASRANI S, et al. Validating a novel score based on interaction between ACLF grade and MELD score to predict waitlist mortality[J]. J Hepatol, 2021, 74( 6): 1355- 1361. DOI: 10.1016/j.jhep.2020.12.003.
    [4]
    ROLLAND Y, CZERWINSKI S, ABELLAN VAN KAN G, et al. Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives[J]. J Nutr Health Aging, 2008, 12( 7): 433- 450. DOI: 10.1007/BF02982704.
    [5]
    KIM G, KANG SH, KIM MY, et al. Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis[J]. PLoS One, 2017, 12( 10): e0186990. DOI: 10.1371/journal.pone.0186990.
    [6]
    CHAN HCN, FEI XZ, LEUNG ELY, et al. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review[J]. Clin Nutr ESPEN, 2023, 54: 382- 397. DOI: 10.1016/j.clnesp.2023.01.023.
    [7]
    TANTAI XX, LIU Y, YEO YH, et al. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis[J]. J Hepatol, 2022, 76( 3): 588- 599. DOI: 10.1016/j.jhep.2021.11.006.
    [8]
    van VUGT JLA, ALFERINK LJM, BUETTNER S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort[J]. J Hepatol, 2018, 68( 4): 707- 714. DOI: 10.1016/j.jhep.2017.11.030.
    [9]
    YAO J, ZHOU XS, YUAN LL, et al. Prognostic value of the third lumbar skeletal muscle mass index in patients with liver cirrhosis and ascites[J]. Clin Nutr, 2020, 39( 6): 1908- 1913. DOI: 10.1016/j.clnu.2019.08.006.
    [10]
    KONG M, GENG N, ZHOU Y, et al. Defining reference values for low skeletal muscle index at the L3 vertebra level based on computed tomography in healthy adults: A multicentre study[J]. Clin Nutr, 2022, 41( 2): 396- 404. DOI: 10.1016/j.clnu.2021.12.003.
    [11]
    LIDORIKI I, SCHIZAS D, MPAILI E, et al. Associations between skeletal muscle mass index, nutritional and functional status of patients with oesophago-gastric cancer[J]. Clin Nutr ESPEN, 2019, 34: 61- 67. DOI: 10.1016/j.clnesp.2019.08.012.
    [12]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific association for the study of the liver(APASL): An update[J]. Hepatol Int, 2019, 13( 4): 353- 390. DOI: 10.1007/s12072-019-09946-3.
    [13]
    CAREY EJ, LAI JC, WANG CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease[J]. Liver Transpl, 2017, 23( 5): 625- 633. DOI: 10.1002/lt.24750.
    [14]
    DURAND F, BUYSE S, FRANCOZ C, et al. Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography[J]. J Hepatol, 2014, 60( 6): 1151- 1157. DOI: 10.1016/j.jhep.2014.02.026.
    [15]
    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[J]. Clin Transl Gastroenterol, 2015, 6( 7): e102. DOI: 10.1038/ctg.2015.31.
    [16]
    KAMATH PS, KIM WR. The model for end-stage liver disease(MELD)[J]. Hepatology, 2007, 45( 3): 797- 805. DOI: 10.1002/hep.21563.
    [17]
    STEWART CA, MALINCHOC M, KIM W RAY, et al. Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease[J]. Liver Transpl, 2007, 13( 10): 1366- 1371. DOI: 10.1002/lt.21129.
    [18]
    van VUGT JA, LEVOLGER S, de BRUIN RF, et al. Systematic review and meta-analysis of the impact of computed tomography-assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation[J]. Am J Transplant, 2016, 16( 8): 2277- 2292. DOI: 10.1111/ajt.13732.
    [19]
    MYERS RP, TANDON P, NEY M, et al. Validation of the five-variable Model for End-stage Liver Disease(5vMELD) for prediction of mortality on the liver transplant waiting list[J]. Liver Int, 2014, 34( 8): 1176- 1183. DOI: 10.1111/liv.12373.
    [20]
    FRONTERA WR, OCHALA J. Skeletal muscle: A brief review of structure and function[J]. Calcif Tissue Int, 2015, 96( 3): 183- 195. DOI: 10.1007/s00223-014-9915-y.
    [21]
    SAM J, NGUYEN GC. Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension[J]. Liver Int, 2009, 29( 9): 1396- 1402. DOI: 10.1111/j.1478-3231.2009.02077.x.
    [22]
    WRIGHT G, NOIRET L, OLDE DAMINK SWM, et al. Interorgan ammonia metabolism in liver failure: The basis of current and future therapies[J]. Liver Int, 2011, 31( 2): 163- 175. DOI: 10.1111/j.1478-3231.2010.02302.x.
    [23]
    REN PP, XIE Q. Treatment and prevention of hepatic encephalopathy with muscle as the target[J]. Chin Hepatol, 2017, 22( 3): 194- 195. DOI: 10.14000/j.cnki.issn.1008-1704.2017.03.002.

    任佩佩, 谢青. 以肌肉为靶点的肝性脑病治疗和预防[J]. 肝脏, 2017, 22( 3): 194- 195. DOI: 10.14000/j.cnki.issn.1008-1704.2017.03.002.
    [24]
    LI JH, YAO J, YUAN LL. Association between sarcopenia and hepatic encephalopathy and advances in diagnosis and treatment[J]. J Clin Hepatol, 2020, 36( 6): 1412- 1414. DOI: 10.3969/j.issn.1001-5256.2020.06.049.

    李建宏, 姚佳, 原丽莉. 肌肉减少症与肝性脑病的关系及诊疗进展[J]. 临床肝胆病杂志, 2020, 36( 6): 1412- 1414. DOI: 10.3969/j.issn.1001-5256.2020.06.049.
    [25]
    PENG H, ZHANG Q, LUO L, et al. A prognostic model of acute-on-chronic liver failure based on sarcopenia[J]. Hepatol Int, 2022, 16( 4): 964- 972. DOI: 10.1007/s12072-022-10363-2.
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