title: A Model to Identify Sarcopenia in Patients With Cirrhosis.
abstract: The severe depletion of muscle mass at the third lumbar vertebral level (sarcopenia) is a marker of malnutrition and is independently associated with mortality in patients with cirrhosis. Instead of monitoring sarcopenia by cross-sectional imaging, we investigated whether ultrasound-based measurements of peripheral muscle mass, measures of muscle function, along with nutritional factors, are associated with severe loss of muscle mass.
  
  
  
  We performed a prospective study of 159 outpatients with cirrhosis (56% male; mean age, 58 ± 10 years; mean model for end-stage liver disease score, 10 ± 3; 60% Child-Pugh class A) evaluated at the Cirrhosis Care Clinic at the University of Alberta Hospital from March 2011 through September 2012. Lumbar skeletal muscle indices were determined by computed tomography or magnetic resonance imaging. We collected clinical data and data on patients' body composition, nutrition, and thigh muscle thickness (using ultrasound analysis). We also measured mid-arm muscle circumference, mid-arm circumference, hand grip, body mass index, and serum level of albumin; patients were evaluated using the subjective global assessment scale. Findings from these analyses were compared with those from cross-sectional imaging, for each sex, using logistic regression analysis.
  
  
  
  Based on cross-sectional imaging analysis, 43% of patients had sarcopenia (57% of men and 25% of women). Results from the subjective global assessment, serum level of albumin, and most nutritional factors were significantly associated with sarcopenia. We used multivariate analysis to develop a model to identify patients with sarcopenia, and developed a nomogram based on body mass index and thigh muscle thickness for patients of each sex. Our model identified men with sarcopenia with an area under the receiver operating characteristic curve value of 0.78 and women with sarcopenia with an area under the receiver operating characteristic curve value of 0.89.
  
  
  
  In a prospective study of patients with cirrhosis, we found that the combination of body mass index and thigh muscle thickness (measured by ultrasound) can identify male and female patients with sarcopenia almost as well as cross-sectional imaging (area under the receiver operating characteristic curve values of 0.78 and 0.89, respectively). These factors might be used in screening and routine nutritional monitoring of patients with cirrhosis.
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: ptandon@ualberta.ca.
authors.forename: Puneeta
authors.initials: P
authors.lastname: Tandon
authors.affiliation: Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Gavin
authors.initials: G
authors.lastname: Low
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Zenith
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Abdel Aziz M
authors.initials: AA
authors.lastname: Shaheen
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Hina
authors.initials: H
authors.lastname: Qamar
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Mansoor
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Carbonneau
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ismond
authors.affiliation: Department of Radiology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sumeer
authors.initials: S
authors.lastname: Mann
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alshimaa
authors.initials: A
authors.lastname: Alaboudy
authors.affiliation: Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Mang
authors.initials: M
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D015992:Body Mass Index; D003661:Decision Support Techniques; D005260:Female; D005355:Fibrosis / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010045:Outpatients; D011446:Prospective Studies; D012372:ROC Curve; D055948:Sarcopenia / Q000000981:diagnostic imaging* / Q000473:pathology*; D044967:Serum / Q000737:chemistry; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: CT; Diagnosis; Muscle Wasting; SGA