TY - JOUR
T1 - Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis
AU - Bhanji, Rahima A.
AU - Moctezuma-Velazquez, Carlos
AU - Duarte-Rojo, Andres
AU - Ebadi, Maryam
AU - Ghosh, Sunita
AU - Rose, Christopher
AU - Montano-Loza, Aldo J.
N1 - Funding Information:
Acknowledgements RAB received a grant from the Canadian Association for the Study of the Liver (CASL) to accomplish her hepatology fellowship. CMV received a grant from Gilead Canada to accomplish his hepatology fellowship. This study has been funded in part by a Clinical Research Award from the American College of Gastroenterology Institute (AML).
Funding Information:
RAB received a grant from the Canadian Association for the Study of the Liver (CASL) to accomplish her hepatology fellowship. CMV received a grant from Gilead Canada to accomplish his hepatology fellowship. This study has been funded in part by a Clinical Research Award from the American College of Gastroenterology Institute (AML). Rahima A. Bhanji, Andres Duarte-Rojo, Carlos Moctezuma-Velazquez, Maryam Ebadi, Sunita Ghosh, Christopher Rose, and Aldo J. Montano-Loza, declare that they have no conflict of interest.
Publisher Copyright:
© 2018, Asian Pacific Association for the Study of the Liver.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background: Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis. Purpose: The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality. Methods: A total of 675 cirrhotic patients were studied. Computed tomography scans were used to analyze the skeletal muscle. Hepatic encephalopathy was defined by either a hepatic encephalopathy-related hospitalization and/or taking ammonia-lowering treatment (i.e., lactulose, rifaximin). Results: Myosteatosis was observed in 348 patients (52%), sarcopenia in 242 (36%), and hepatic encephalopathy in 128 (19%) patients. Both myosteatosis (70 vs. 45%, p < 0.001) and sarcopenia (53 vs. 32%, p < 0.001) were more frequent in patients with hepatic encephalopathy. By multivariable regression analysis, both myosteatosis and sarcopenia were associated with a higher risk of hepatic encephalopathy, independent of the MELD score (OR 2.25; 95% CI, 1.32–3.85, p = 0.003 and OR 2.42; 95% CI, 1.43–4.10, p = 0.001, respectively). In univariate Cox proportional hazards analysis, sarcopenia (csHR 2.02; 95% CI, 1.57–2.58, p < 0.001), myosteatosis (csHR 1.45; 95% CI, 1.16–2.91, p = 0.004), and hepatic encephalopathy (csHR 1.61; 95% CI, 1.20–2.18, p = 0.002) were associated with mortality, but only sarcopenia was significant in the multivariable analysis (csHR 2.15; 95% CI, 1.52–3.05, p < 0.001). Conclusions: Myosteatosis and sarcopenia are independently associated with overt hepatic encephalopathy in patients with cirrhosis. The association between hepatic encephalopathy and mortality may be explained at least partially by the presence of sarcopenia. These results identify the importance of muscle mass and suggest therapeutic strategies to attenuate muscle mass loss and improve muscle quality.
AB - Background: Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis. Purpose: The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality. Methods: A total of 675 cirrhotic patients were studied. Computed tomography scans were used to analyze the skeletal muscle. Hepatic encephalopathy was defined by either a hepatic encephalopathy-related hospitalization and/or taking ammonia-lowering treatment (i.e., lactulose, rifaximin). Results: Myosteatosis was observed in 348 patients (52%), sarcopenia in 242 (36%), and hepatic encephalopathy in 128 (19%) patients. Both myosteatosis (70 vs. 45%, p < 0.001) and sarcopenia (53 vs. 32%, p < 0.001) were more frequent in patients with hepatic encephalopathy. By multivariable regression analysis, both myosteatosis and sarcopenia were associated with a higher risk of hepatic encephalopathy, independent of the MELD score (OR 2.25; 95% CI, 1.32–3.85, p = 0.003 and OR 2.42; 95% CI, 1.43–4.10, p = 0.001, respectively). In univariate Cox proportional hazards analysis, sarcopenia (csHR 2.02; 95% CI, 1.57–2.58, p < 0.001), myosteatosis (csHR 1.45; 95% CI, 1.16–2.91, p = 0.004), and hepatic encephalopathy (csHR 1.61; 95% CI, 1.20–2.18, p = 0.002) were associated with mortality, but only sarcopenia was significant in the multivariable analysis (csHR 2.15; 95% CI, 1.52–3.05, p < 0.001). Conclusions: Myosteatosis and sarcopenia are independently associated with overt hepatic encephalopathy in patients with cirrhosis. The association between hepatic encephalopathy and mortality may be explained at least partially by the presence of sarcopenia. These results identify the importance of muscle mass and suggest therapeutic strategies to attenuate muscle mass loss and improve muscle quality.
KW - Hepatic encephalopathy
KW - Liver cirrhosis
KW - Liver transplantation
KW - Nutrition
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U2 - 10.1007/s12072-018-9875-9
DO - 10.1007/s12072-018-9875-9
M3 - Article
C2 - 29881992
AN - SCOPUS:85048087037
SN - 1936-0533
VL - 12
SP - 377
EP - 386
JO - Hepatology International
JF - Hepatology International
IS - 4
ER -