title: Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis.
abstract: OBJECTIVE
  Sarcopenia impairs the outcome of patients with liver cirrhosis independently of liver function reserves. The aim of this study was to investigate whether the rate of skeletal muscle wasting predicts mortality in cirrhotic patients.
  
  
  METHODS
  This retrospective study evaluated 149 cirrhotic patients who visited our hospital between March 2004 and September 2012. The skeletal muscle cross-sectional area at the level of the third lumbar vertebra was measured by computed tomography, from which the skeletal muscle index was obtained for diagnosis of sarcopenia. The relative change in skeletal muscle area per year (ΔSMA/y) was calculated in each patient. Cox proportional hazards regression analysis was performed to evaluate risk factors for mortality.
  
  
  RESULTS
  Of the 149 cirrhotic patients, 94 (63%) were diagnosed with sarcopenia. The median of ΔSMA/y in all patients was -2.2%. For patients in Child-Pugh class A, B and C, ΔSMA/y was -1.3%, -3.5% and -6.1%, respectively. During a median follow-up period of 39 months (range, 1-110), 45 patients (30%) died. The optimal cut-off value of ΔSMA/y for predicting mortality was -3.1%; the survival rate in patients with ΔSMA/y of -3.1% or less was significantly lower than in patients with ΔSMA/y of more than -3.1% (P < 0.0001). The multivariate Cox proportional hazards model found ΔSMA/y of -3.1% or less to be significantly associated with mortality in cirrhotic patients (hazard ratio = 2.73, 95% confidence interval = 1.43-5.44, P < 0.01).
  
  
  CONCLUSIONS
  ΔSMA/y is useful for predicting mortality in patients with liver cirrhosis. Management of skeletal muscle may contribute toward improving the outcome of cirrhotic patients.
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Hanai
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shiraki
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Ohnishi
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Takayasu
authors.initials: T
authors.lastname: Ideta
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kochi
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Imai
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suetsugu
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.|Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takai
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
authors.affiliation: Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
keywords: Model for End-Stage Liver Disease; mortality; prognosis; sarcopenia; skeletal muscle index