Fat‐free muscle mass in magnetic resonance imaging predicts ... : Hepatology (original) (raw)

Original Articles: LIVER FAILURE/CIRRHOSIS/PORTAL HYPERTENSION

Fat‐free muscle mass in magnetic resonance imaging predicts acute‐on‐chronic liver failure and survival in decompensated cirrhosis

Praktiknjo, Michael1,†; Book, Marius1,†; Luetkens, Julian2; Pohlmann, Alessandra1; Meyer, Carsten2; Thomas, Daniel2; Jansen, Christian1; Feist, Andreas2; Chang, Johannes1; Grimm, Jochen3; Lehmann, Jennifer1; Strassburg, Christian P.1; Abraldes, Juan Gonzalez4; Kukuk, Guido2,‡; Trebicka, Jonel*,1,5,6,7,‡

1Department of Internal Medicine IUniversity of BonnBonnGermany

2Department of RadiologyUniversity of BonnBonnGermany

3Department of Radiodiagnostic and Interventional RadiologyLausanne University HospitalLausanneSwitzerland

4Division of GastroenterologyUniversity of AlbertaAlbertaCanada

5Department of Gastroenterology, Odense HospitalUniversity of Southern DenmarkOdenseDenmark

6European Foundation for the Study of Chronic Liver FailureBarcelonaSpain

7Institute for Bioengineering of CataloniaBarcelonaSpain

* ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:
Jonel Trebicka, M.D., Ph.D.
Department of Internal Medicine I, University of Bonn
Sigmund‐Freud‐Str. 25
53127 Bonn, Germany
E‐mail: [email protected]
Tel: +49‐228‐287‐15507

†These are co‐first authors.

‡These are co‐last authors.

Abstract

Muscle mass seems to be a prognostic marker in patients with liver cirrhosis. However, reported methods to quantify muscle mass are heterogeneous, consented cutoff values are missing, and most studies have used computed tomography. This study evaluated fat‐free muscle area (FFMA) as a marker of sarcopenia using magnetic resonance imaging (MRI) in patients with decompensated cirrhosis with transjugular intrahepatic portosystemic shunt (TIPS). The total erector spinae muscle area and the intramuscular fat tissue area were measured and subtracted to calculate the FFMA in 116 patients with cirrhosis by TIPS and MRI. The training cohort of 71 patients compared computed tomography–measured transversal psoas muscle thickness with FFMA. In 15 patients MRI was performed before and after TIPS, and in 12 patients follistatin serum measurements were carried out. The results on FFMA were confirmed in a validation cohort of 45 patients. FFMA correlated with follistatin and transversal psoas muscle thickness and showed slightly better association with survival than transversal psoas muscle thickness. Gender‐specific cutoff values for FFMA were determined for sarcopenia. Decompensation (ascites, overt hepatic encephalopathy) persisted after TIPS in the sarcopenia group but resolved in the nonsarcopenia group. Sarcopenic patients showed no clinical improvement after TIPS as well as higher mortality, mainly due to development of acute‐on‐chronic liver failure. FFMA was an independent predictor of survival in these patients. Conclusion: This study offers an easy‐to‐apply MRI‐based measurement of fat‐free muscle mass as a marker of sarcopenia in decompensated patients; while TIPS might improve sarcopenia and thereby survival, persistence of sarcopenia after TIPS is associated with a reduced response to TIPS and a higher risk of acute‐on‐chronic liver failure development and mortality. (Hepatology 2018;67:1014–1026)