Constraining Effect of Mild Portal Hypertension against the Negative Influence of Muscle Mass Loss in Cirrhosis after Esophageal Variceal Eradication

Background: To elucidate the role of muscle mass loss (MML) in the long-term outcome of cirrhosis after the endoscopic eradication of esophageal varices (EV). Methods and findings: This is a subgroup analysis of 82 prospectively enrolled cirrhosis patients with eradicated EV. A severe portal hypertension (PH) was defined by post-treatment hepatic venous pressure gradient ≥12 mmHg. MML was assessed by skeletal muscle index at the L3 lesion (cm2/m2) with the cut-off values of 38 for women and 42 for men (median observation period, 37.4 months). Twenty-four patients (29.3%) had MML. Multivariate analysis showed that a presence of hepatocellular carcinoma (P<0.0001) and a presence of MML (P=0.002) were significant prognostic factors. In the cohort with severe PH, the survival rate was significantly lower in patients with MML than in those without. However, in the cohort without severe PH, the survival rate showed no difference between patients with MML (100% at 1year, 50% at 3 years and 5 years) and those without (92.3% at 1 year and 3 years, 71.8% at 5 years; P=0.278). Conclusions: MML is an independent prognostic factor after the eradication of EV in cirrhosis, and the mild PH exerts a constraining effect against the negative influence of MML.