title: Prognostic significance of low skeletal muscle mass compared with protein-energy malnutrition in liver cirrhosis.
abstract: OBJECTIVE
  To investigate the impact of low skeletal muscle mass (LSMM) on survival as compared with protein-energy malnutrition (PEM) in patients with liver cirrhosis (LC).
  
  
  METHODS
  A total of 206 individuals with LC were analyzed. We retrospectively examined the impact of LSMM, as defined by psoas muscle mass at the third lumber on computed tomography, on survival as compared with PEM. In terms of comparison of the effects of LSMM and PEM on survival, we used time-dependent receiver operating characteristics (ROC) analysis.
  
  
  RESULTS
  Our study cohort included 115 men and 91 women with a median age of 67 years. There were 140 patients with Child-Pugh A, 62 with Child-Pugh B, and 4 with Child-Pugh C. A total of 117 patients (56.8%) had LSMM and 52 patients (25.2%) had PEM. The proportion of PEM in patients with LSMM (31.62%, 37/117) was significantly higher than in patients without LSMM (16.85%, 15/89) (P = 0.0229). In the multivariate analysis for the entire cohort, the presence of hepatocellular carcinoma, lower body mass index, presence of LSMM, lower triglyceride value, poorer renal function, and higher des-γ-carboxy prothrombin value were found to be significant adverse predictors linked to overall survival, while presence of PEM tended to be significant. In the time-dependent ROC analysis, all area under the ROCs for survival in LSMM at each time point were higher than those in PEM except for Child-Pugh B patients.
  
  
  CONCLUSIONS
  In this comparison of LSMM and PEM on clinical outcomes in LC patients, it was shown that LSMM may have stronger prognostic impact than PEM.
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishikawa
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hirayuki
authors.initials: H
authors.lastname: Enomoto
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Ishii
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Iwata
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yuho
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Yuri
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takata
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Chikage
authors.initials: C
authors.lastname: Nakano
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yoh
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Aizawa
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Ikeda
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takashima
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.affiliation: Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
keywords: clinical outcomes; comparison; liver cirrhosis; low skeletal muscle mass; protein-energy malnutrition