Sarcopenia is associated with short- and long-term mortality in patients with acute-on-chronic liver failure

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-07-05 DOI:10.1002/jcsm.13501

Fan Zeng, Wei Jiang, Xiujun Chang, Fuxun Yang, Xiaoxiu Luo, Rongan Liu, Yu Lei, Jiajia Li, Chun Pan, Xiaobo Huang, Huaiqiang Sun, Yunping Lan

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Abstract

Background

While sarcopenia is recognized as a predictor of mortality in cirrhosis, its influence on acute-on-chronic liver failure (ACLF) remains uncertain. Despite multiple studies examining the impact of sarcopenia on short-term mortality in patients with ACLF, the sample size of these studies was limited, and their outcomes were inconsistent. Therefore, this study aimed to explore the impact of sarcopenia on both short- and long-term mortality in patients with ACLF.

Methods

This retrospective cohort study included 414 patients with ACLF that were treated between January 2016 and September 2022. Sarcopenia was diagnosed based on the measurement of the skeletal muscle index at the third lumbar vertebra (L3-SMI). Subsequently, the patients were divided into sarcopenia and non-sarcopenia groups. We analysed the basic clinical data of the two groups. Multivariate Cox proportional analysis was used to analyse short-term (28 days) and long-term (1 year and overall) mortality rates.

Results

A total of 414 patients were included, with a mean age of 52.88 ± 13.41 years. Among them, 318 (76.8%) were male, and 239 (57.7%) had sarcopenia. A total of 280 (67.6%) patients died during the study period. Among them, 153 patients died within 28 days (37%) and 209 patients died within 1 year (50.5%). We found that the 28-day, 1-year and overall mortality rates in the sarcopenia group were significantly higher than those in the non-sarcopenia group (37% vs. 22.3%, P < 0.01; 50.5% vs. 34.9%, P < 0.01; and 67.6% vs. 53.1%, P < 0.01, respectively). Multivariate Cox regression analysis revealed that sarcopenia was significantly associated with increased mortality. The hazard ratios for sarcopenia were 2.05 (95% confidence interval [CI] 1.41–3.00, P < 0.01) for 28-day mortality, 1.81 (95% CI 1.29–2.54, P < 0.01) for 1-year mortality and 1.82 (95% CI 1.30–2.55, P < 0.01) for overall mortality. In addition, muscle density and international normalized ratio were associated with short- and long-term mortality.

Conclusions

Sarcopenia is associated with both short- and long-term mortality in patients with ACLF. Therefore, regular monitoring for sarcopenia is important for these patients.

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肌肉疏松症与急性-慢性肝衰竭患者的短期和长期死亡率有关。

背景：虽然肌肉疏松症被认为是肝硬化死亡率的预测因素，但其对急性-慢性肝衰竭（ACLF）的影响仍不确定。尽管有多项研究探讨了肌肉疏松症对急性慢性肝衰竭患者短期死亡率的影响，但这些研究的样本量有限，研究结果也不一致。因此，本研究旨在探讨肌肉疏松症对 ACLF 患者短期和长期死亡率的影响：这项回顾性队列研究纳入了 414 名在 2016 年 1 月至 2022 年 9 月期间接受治疗的 ACLF 患者。根据第三腰椎骨骼肌指数（L3-SMI）的测量结果诊断患者是否患有肌肉疏松症。随后，患者被分为肌肉疏松症组和非肌肉疏松症组。我们分析了两组患者的基本临床数据。我们采用多变量考克斯比例分析法来分析短期（28 天）和长期（1 年和总体）死亡率：共纳入 414 名患者，平均年龄（52.88±13.41）岁。其中，318 人（76.8%）为男性，239 人（57.7%）患有肌肉疏松症。共有 280 名（67.6%）患者在研究期间死亡。其中，153 名患者在 28 天内死亡（37%），209 名患者在 1 年内死亡（50.5%）。我们发现，肌肉疏松症组的 28 天、1 年和总死亡率明显高于非肌肉疏松症组（37% 对 22.3%，P 结论：肌肉疏松症与前交叉韧带纤维化患者的短期和长期死亡率有关。因此，定期监测肌肉疏松症对这些患者非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.