title: Prognostic value of muscle atrophy in cirrhosis using psoas muscle thickness on computed tomography.
abstract: OBJECTIVE
  Waiting-list mortality in patients with cirrhosis and a relatively low MELD score is a matter of concern. The aim of this study was to determine whether a marker of muscle waste could improve prognostication.
  
  
  METHODS
  A pre-MELD cohort (waiting time-based allocation; n=186) and a MELD-era cohort (n=376) were examined. At evaluation, transversal psoas muscle thickness (TPMT) was measured on a computed tomography (CT) image at the level of the umbilicus. In the pre-MELD cohort, TPMT/height (mm/m) and the MELD score were entered in univariate and multivariate models to predict mortality after registration. Applicability of pre-MELD findings was tested in the MELD-era.
  
  
  RESULTS
  In the pre-MELD cohort, the MELD score and TPMT/height were significantly associated with mortality. The discrimination of a score combining MELD and TPMT/height (MELD-psoas) was 0.84 (95% CI, 0.62-0.95). In the MELD-era, TPTM/height was significantly associated with mortality, independent of the MELD and MELD-Na scores. There was a 15% increase in mortality risk per unit decrease in TPMT/height. The discrimination of MELD-psoas score (0.82; 95% CI, 0.64-0.93) was superior to that of the MELD score and similar to that of the MELD-Na score. In patients with refractory ascites, mortality was significantly higher when TPMT/height was <16.8 mm/m (42% vs. 9%, p=0.02).
  
  
  CONCLUSIONS
  TPMP/height on CT at the level of the umbilicus, an objective marker of muscle waste, may be predictive of mortality in cirrhotic patients, independent of the MELD and MELD-Na scores. It may help to better assess the prognosis of patients with refractory ascites.
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France. Electronic address: francois.durand@bjn.aphp.fr.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Buyse
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Francoz
authors.affiliation: Biostatistics Department, Hospital Bichat, Paris, France; INSERM UMR 738, Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Laouénan
authors.affiliation: Department of Radiology, Hospital Beaujon, Clichy, France.
authors.forename: Onorina
authors.initials: O
authors.lastname: Bruno
authors.affiliation: Hepatobiliary Surgery and Liver Transplantation, Hospital Beaujon, Clichy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.affiliation: INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France; Department of Radiology, Hospital Beaujon, Clichy, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
authors.affiliation: Hepatology and Liver Intensive Care Unit, Hospital Beaujon, Clichy, France; INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valla
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016658:Psoas Muscles / Q000000981:diagnostic imaging*; D012307:Risk Factors; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000401:mortality; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014850:Waiting Lists / Q000401:mortality
keywords: Cirrhosis; Liver transplantation; MELD score; Refractory ascites; Sarcopenia