TY - JOUR
T1 - Inclusion of sarcopenia within MELD (MELD-Sarcopenia) and the prediction of mortality in patients with cirrhosis
AU - Montano-Loza, Aldo J.
AU - Duarte-Rojo, Andres
AU - Meza-Junco, Judith
AU - Baracos, Vickie E.
AU - Sawyer, Michael B.
AU - Pang, Jack X.Q.
AU - Beaumont, Crystal
AU - Esfandiari, Nina
AU - Myers, Robert P.
N1 - Funding Information:
Michael B. Sawyer: analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Jack X.Q. Pang: analysis and interpretation of data, critical revision of the manuscript for important intellectual content. Crystal Beaumont: computed tomography analysis, critical revision of the manuscript for important intellectual content. Nina Esfandiari: computed tomography analysis, critical revision of the manuscript for important intellectual content. Robert P. Myers: study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; study supervision. Financial support: This study has been funded with a Clinical Research Award from the American College of Gastroenterology Institute, 2011. Potential competing interests: None.
Publisher Copyright:
© 2015 the American College of Gastroenterology All rights reserved.
PY - 2015/7/16
Y1 - 2015/7/16
N2 - 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.
AB - 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.
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U2 - 10.1038/ctg.2015.31
DO - 10.1038/ctg.2015.31
M3 - Article
C2 - 26181291
AN - SCOPUS:84989354511
SN - 2155-384X
VL - 6
JO - Clinical and Translational Gastroenterology
JF - Clinical and Translational Gastroenterology
IS - 7
M1 - e102
ER -