title: Muscle wasting is associated with mortality in patients with cirrhosis.
abstract: OBJECTIVE
  Sarcopenia, defined as a low level of muscle mass, occurs in patients with cirrhosis. We assessed its incidence among cirrhotic patients undergoing evaluation for liver transplantation to investigate associations between sarcopenia and mortality and prognosis.
  
  
  METHODS
  We studied 112 patients with cirrhosis (78 men; mean age, 54 ± 1 years) who were consecutively evaluated for liver transplantation and had a computed tomography scan at the level of the third lumbar (L3) vertebrae to determine the L3 skeletal muscle index; sarcopenia was defined by using previously published, sex-specific cutoffs.
  
  
  RESULTS
  Of the patients studied, 45 (40%) had sarcopenia. Univariate Cox analysis associated mortality with ascites (hazard ratio [HR], 2.12; P = .04), encephalopathy (HR, 1.99; P = .04), level of bilirubin (HR, 1.007; P < .01), international normalized ratio (HR, 7.69; P < .001), level of creatinine (HR, 1.01; P = .005), level of albumin (HR, 94; P = .008), serum level of sodium (HR, 89; P < .001), Model for End-Stage Liver Disease (MELD) score (HR, 1.14; P < .01), Child-Pugh score (HR, 2.84; P < .001), and sarcopenia (HR, 2.18; P = .006). By multivariate Cox analysis, only Child-Pugh (HR, 1.85; P = .04) and MELD scores (HR, 1.08; P = .001) and sarcopenia (HR, 2.21; P = .008) were independently associated with mortality. The median survival time for patients with sarcopenia was 19 ± 6 months, compared with 34 ± 11 months among nonsarcopenia patients (P = .005). There was a low level of correlation between L3 skeletal muscle index and MELD (r = -0.07; P = .5) and Child-Pugh scores (r = -0.14; P = .1).
  
  
  CONCLUSIONS
  Sarcopenia is associated with mortality in patients with cirrhosis. It does not correlate with the degree of liver dysfunction evaluated by using conventional scoring systems. Scoring systems should include evaluation of sarcopenia to better assess mortality among patients with cirrhosis.
authors: Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada. aldo.montano-loza@ualberta.ca
authors: Aldo J
authors: AJ
authors: Montano-Loza
authors: Judith
authors: J
authors: Meza-Junco
authors: Carla M M
authors: CM
authors: Prado
authors: Jessica R
authors: JR
authors: Lieffers
authors: Vickie E
authors: VE
authors: Baracos
authors: Vincent G
authors: VG
authors: Bain
authors: Michael B
authors: MB
authors: Sawyer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009132:Muscles; D055948:Sarcopenia / Q000150:complications* / Q000473:pathology*; D012720:Severity of Illness Index; D016019:Survival Analysis