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Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis.

Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, Baracos VE, Sawyer MB, Pang JX, Beaumont C, Esfandiari N, Myers RP - Clin Transl Gastroenterol (2015)

Bottom Line: By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality.The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.

ABSTRACT

Objectives: Limitations of the Model for End-Stage Liver Disease (MELD) score include its failure to assess the nutritional and functional status of cirrhotic patients. Our objectives were to evaluate the impact of sarcopenia in cirrhosis and whether the inclusion of muscularity assessment within MELD could improve the prediction of mortality in patients with cirrhosis.

Methods: We included 669 cirrhotic patients who were consecutively evaluated for liver transplantation. Skeletal muscle index at the third lumbar vertebra (L3 SMI) was measured by computed tomography, and sarcopenia was defined using previously published gender and body mass index-specific cutoffs. Using Cox proportional hazards regression, a novel MELD-sarcopenia score was derived.

Results: Sarcopenia was present in 298 patients (45%); sarcopenic patients had shorter median survival than non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality. Overall, the c-statistics for 3-month mortality were 0.82 (95% CI 0.78-0.87) for MELD and 0.85 (95% CI 0.81-0.88) for MELD-sarcopenia (P=0.1). Corresponding figures for 1-year mortality were 0.73 (95% CI 0.69-0.77) and 0.77 (95% CI 0.73-0.80), respectively (P=0.03). The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.

Conclusions: Modification of MELD to include sarcopenia is associated with improved prediction of mortality in patients with cirrhosis, primarily in patients with low MELD scores. External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier curves indicating the survival of patients with (—) and without (—) sarcopenia. The 3-month estimated probabilities of survival in patients with and without cirrhosis were 80% and 93%, respectively. Corresponding figures at 6 and 12 months were 71% and 90% and 53% and 83%, respectively (all P<0.00005 by log-rank tests).
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fig3: Kaplan–Meier curves indicating the survival of patients with (—) and without (—) sarcopenia. The 3-month estimated probabilities of survival in patients with and without cirrhosis were 80% and 93%, respectively. Corresponding figures at 6 and 12 months were 71% and 90% and 53% and 83%, respectively (all P<0.00005 by log-rank tests).

Mentions: During a mean follow-up of 22±1 months (median, 11 months; range, 0.5–164 months), 229 patients received a liver transplant (34%) and 259 died (39%). Mean survival was shorter in patients with sarcopenia compared with non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). The estimated 3-month probability of survival was 81% in patients with sarcopenia compared with 93% in patients without sarcopenia. The 6-month and 1-year probabilities of survival were 72% and 61%, compared with 89% and 83% in sarcopenic and non-sarcopenic patients, respectively (Figure 3).


Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients With Cirrhosis.

Montano-Loza AJ, Duarte-Rojo A, Meza-Junco J, Baracos VE, Sawyer MB, Pang JX, Beaumont C, Esfandiari N, Myers RP - Clin Transl Gastroenterol (2015)

Kaplan–Meier curves indicating the survival of patients with (—) and without (—) sarcopenia. The 3-month estimated probabilities of survival in patients with and without cirrhosis were 80% and 93%, respectively. Corresponding figures at 6 and 12 months were 71% and 90% and 53% and 83%, respectively (all P<0.00005 by log-rank tests).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4816259&req=5

fig3: Kaplan–Meier curves indicating the survival of patients with (—) and without (—) sarcopenia. The 3-month estimated probabilities of survival in patients with and without cirrhosis were 80% and 93%, respectively. Corresponding figures at 6 and 12 months were 71% and 90% and 53% and 83%, respectively (all P<0.00005 by log-rank tests).
Mentions: During a mean follow-up of 22±1 months (median, 11 months; range, 0.5–164 months), 229 patients received a liver transplant (34%) and 259 died (39%). Mean survival was shorter in patients with sarcopenia compared with non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). The estimated 3-month probability of survival was 81% in patients with sarcopenia compared with 93% in patients without sarcopenia. The 6-month and 1-year probabilities of survival were 72% and 61%, compared with 89% and 83% in sarcopenic and non-sarcopenic patients, respectively (Figure 3).

Bottom Line: By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality.The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.

ABSTRACT

Objectives: Limitations of the Model for End-Stage Liver Disease (MELD) score include its failure to assess the nutritional and functional status of cirrhotic patients. Our objectives were to evaluate the impact of sarcopenia in cirrhosis and whether the inclusion of muscularity assessment within MELD could improve the prediction of mortality in patients with cirrhosis.

Methods: We included 669 cirrhotic patients who were consecutively evaluated for liver transplantation. Skeletal muscle index at the third lumbar vertebra (L3 SMI) was measured by computed tomography, and sarcopenia was defined using previously published gender and body mass index-specific cutoffs. Using Cox proportional hazards regression, a novel MELD-sarcopenia score was derived.

Results: Sarcopenia was present in 298 patients (45%); sarcopenic patients had shorter median survival than non-sarcopenic patients (20±3 vs. 95±24 months, P<0.001). By Cox regression analysis adjusted for age, gender, and hepatocellular carcinoma, both MELD (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.06-1.10, P<0.001), and the L3 SMI (HR 0.97, 95% CI 0.96-0.99, P<0.001) were associated with mortality. Overall, the c-statistics for 3-month mortality were 0.82 (95% CI 0.78-0.87) for MELD and 0.85 (95% CI 0.81-0.88) for MELD-sarcopenia (P=0.1). Corresponding figures for 1-year mortality were 0.73 (95% CI 0.69-0.77) and 0.77 (95% CI 0.73-0.80), respectively (P=0.03). The c-statistics for 3-month mortality in patients with MELD<15 (0.85 vs. 0.69, P=0.02) and refractory ascites (0.74 vs. 0.71, P=0.01) were significantly higher for MELD-sarcopenia compared with MELD.

Conclusions: Modification of MELD to include sarcopenia is associated with improved prediction of mortality in patients with cirrhosis, primarily in patients with low MELD scores. External validation of this prognostic index in larger cohorts of cirrhotic patients is warranted.

No MeSH data available.


Related in: MedlinePlus