BackgroundIt has been shown that in patients with liver cirrhosis, sarcopenia is a predictor of acute decompensation (AD), acute‐on‐chronic liver failure (ACLF) and death. However, computer tomography (CT), as a suggested standard method for diagnosing sarcopenia, is resource intensive and involves radiation exposure. Therefore, in this study, we evaluate the muscle thickness of quadriceps femoris measured by ultrasound (US) as a prognostic parameter for AD and all‐cause mortality in chronic liver disease.MethodsSixty‐three patients with chronic liver disease and signs of portal hypertension were analysed in this prospective monocentric study for the occurrence of acute decompensation such as hepatic encephalopathy, ascites, haemorrhage and liver‐related death within 1 year. We assessed muscle thickness at three different heights in terms of suitability as a predictor.ResultsAmong all 63 patients, 15 patients experienced acute decompensation, and 9 patients died due to liver‐related death. We found the upper third of the muscle, measured without applying pressure with the transducer, to be the most significant for predicting AD/ACLF [AUC 0.739 (confidence interval (CI) 0.604–0.874, p = 0.006]. A cut‐off value of US‐defined muscle thickness standardized per height for identifying sarcopenia was determined (1.83 cm/m). Patients with US‐defined sarcopenia showed significantly higher rates of AD (38.9% vs. 3.7%, p = 0.001) and all‐over 1‐year mortality (27.8% vs. 3.7%, p = 0.013). The mean AD free survival time is 8.3 months (95% CI 6.6–9.9) for sarcopenic patients and 11.8 months (95% CI 11.0–12.6) for the non‐sarcopenic cohorts. Corresponding CT analysis displayed similar results for AD free survival for both groups (40% AD rate in the sarcopenic group vs. 7% AD rate in the non‐sarcopenic group, p = 0.001). The risk for AD was significantly higher in the sarcopenic cohort compared with those without sarcopenia in both US and CT (US: HR 16.6; p = 0.009; 95% CI 2.0–136.0; CT: HR 8.7; p = 0.017; 95% CI 1.5–51.0). CT and US displayed a moderate agreement (p = 0.006; κ = 0.379).ConclusionsSarcopenia classification based on US measurements is shown to be an independent predictor of AD occurrence within 1 year. This pilot study is the first to suggest that screening for sarcopenia by ultrasonography may be useful for risk assessment in patients with chronic liver disease and signs of portal hypertension.

中文翻译：

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超声定义的肌肉减少症独立预测晚期慢性肝病的急性失代偿


背景研究表明，在肝硬化患者中，肌肉减少症是急性失代偿 （AD）、慢加急性肝衰竭 （ACLF） 和死亡的预测指标。然而，计算机断层扫描 （CT） 作为诊断肌肉减少症的推荐标准方法，需要大量资源并涉及辐射暴露。因此，在这项研究中，我们评估了超声 （US） 测量的股四头肌肌肉厚度作为 AD 和慢性肝病全因死亡率的预后参数。方法在这项前瞻性单中心研究中，分析了 63 例慢性肝病和门静脉高压症体征患者 1 年内肝性脑病、腹水、出血和肝脏相关死亡等急性失代偿的发生情况。我们评估了三种不同身高的肌肉厚度作为预测因子的适用性。结果在所有 63 例患者中，15 例患者出现急性失代偿，9 例患者因肝脏相关死亡而死亡。我们发现，在没有用换能器施加压力的情况下测量的肌肉上三分之一对预测 AD/ACLF 最显着 [AUC 0.739 （置信区间 （CI） 0.604–0.874，p = 0.006]。确定了用于识别肌肉减少症的美国定义肌肉厚度的临界值 （1.83 cm/m）。美国定义的肌肉减少症患者的 AD 发生率 （38.9% vs. 3.7%，p = 0.001） 和整体 1 年死亡率 （27.8% vs. 3.7%，p = 0.013） 显著升高。肌肉减少症患者的平均无 AD 生存时间为 8.3 个月 （95% CI 6.6-9.9），非肌肉减少症队列为 11.8 个月 （95% CI 11.0-12.6）。相应的 CT 分析显示两组无 AD 生存率相似（肌肉减少组 40% AD 率 vs. 非肌肉减少组的 AD 率为 7%，p = 0.001）。与 US 和 CT 中没有肌肉减少症的患者相比，肌肉减少队列中 AD 的风险显着更高 （US： HR 16.6;p = 0.009;95% CI 2.0–136.0;CT：心率 8.7;p = 0.017;95% CI 1.5–51.0）。CT 和 US 显示出中等一致性 （p = 0.006;κ = 0.379）。结论基于 US 测量的肌肉减少症分类被证明是 1 年内 AD 发生的独立预测因子。这项初步研究首次表明通过超声检查筛查肌肉减少症可能有助于慢性肝病和门静脉高压症体征患者的风险评估。