Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt

doi:10.3748/wjg.v29.i18.2875

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May 14, 2023 (publication date) through May 6, 2024

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. May 14, 2023; 29(18): 2875-2887
Published online May 14, 2023. doi: 10.3748/wjg.v29.i18.2875

Table 1 Demographic data, relevant clinical characteristics, and skeletal muscle abnormalities of patients in the study

Variables	All patients (n = 108)	Non-HE (n = 59)	HE (n = 49)	P value
Age (years)	53.0 ± 10.8	50.3 ± 9.6	56.2 ± 11.5	0.005^a
Gender (male), n, %	84 (77.8)	47 (79.7)	37 (75.5)	0.605
BMI (kg/m²)	20.99 ± 2.59	21.00 ± 2.58	20.96 ± 2.63	0.856
Etiology (n, %)
Viral hepatitis	74 (68.5)	42 (71.2)	32 (65.3)	0.512
Others	34 (31.5)	17 (28.8)	17 (34.7)
Ascites (n, %)
Yes	74 (68.5)	41 (69.5)	33 (67.3)	0.811
No	34 (31.5)	18 (30.5)	16 (32.7)
Child-Pugh score	7.4 ± 1.5	6.9 ± 1.2	7.9 ± 1.8	0.002^a
Child-Pugh class A/B/C (n)	38/59/11	25/30/4	13/29/7	0.155
MELD score	11.0 ± 4.4	9.3 ± 3.8	13.0 ± 4.3	< 0.001^a
NLR	4.4 ± 4.1	3.9 ± 4.5	4.9 ± 3.5	0.015^a
TBIL (umol/L)	22.8 ± 12.9	19.1 ± 9.4	27.3 ± 15.0	0.003^a
ALT (U/L)	27.5 ± 19.7	27.1 ± 16.9	28.0 ± 22.8	0.610
AST (U/L)	37.8 ± 28.6	32.0 ± 16.5	44.9 ± 37.4	0.071
Albumin (g/L)	32.6 ± 5.0	33.2 ± 5.3	31.9 ± 4.7	0.161
Creatinine (umol/L)	67.8 ± 25.7	66.6 ± 23.4	69.1 ± 28.5	0.858
Reduction of PPG (%)	53.7 ± 9.1	51.5 ± 9.1	56.5 ± 8.5	0.004^a
PMA (HU)	43.5 ± 6.9	46.3 ± 6.6	40.2 ± 5.7	< 0.001^a
Myosteatosis	35 (32.4)	10 (16.9)	25 (51.0)	< 0.001^a
No myosteatosis	73 (67.6)	49 (83.1)	24 (49.0)
TPMT (mm/m)	11.6 ± 3.1	12.6 ± 2.9	10.4 ± 3.1	< 0.001^a
Sarcopenia	31 (28.7)	11 (18.6)	20 (40.8)	0.011^a
No sarcopenia	77 (71.3)	48 (81.4)	29 (59.2)

^aP < 0.05.

HE: Hepatic encephalopathy; BMI: Body mass index; MELD: Model for end-stage liver disease; NLR: Neutrophil-lymphocyte ratio; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate transaminase; PPG: Portosystemic pressure gradient; PMA: Psoas muscle attenuation; TPMT: Transversal psoas muscle thickness; HU: Hounsfield units.

Table 2 Prognostic factors for overt hepatic encephalopathy in patients treated with transjugular intrahepatic portosystemic shunt

Characteristics	Univariate analysis			Multivariate analysis
Characteristics	HR	95%CI	P value	HR	95%CI	P value
Age (years)	1.044	(1.016-1.071)	0.001^a	1.043	(1.017-1.069)	0.330
Gender (male)	1.207	(0.629-2.316)	0.572
BMI (kg/m²)	1.012	(0.902-1.134)	0.844
Etiology (viral hepatitis/others)	1.277	(0.706-2.310)	0.418
Ascites (yes/no)	0.845	(0.465-1.536)	0.580
Child-Pugh score	1.292	(1.091-1.531)	0.003^a	1.078	(0.832-1.397)	0.740
MELD score	1.137	(1.074-1.203)	< 0.001^a	1.083	(1.020-1.449)	0.009^a
NLR	1.041	(0.984-1.101)	0.161
TBIL (umol/L)	1.033	(1.014-1.053)	0.001^a	1.029	(1.000-1.058)	0.768
ALT (U/L)	1.003	(0.989-1.018)	0.681
AST (U/L)	1.010	(0.998-1.023)	0.107
Albumin (g/L)	0.956	(0.903-1.013)	0.128
Creatinine (umol/L)	1.004	(0.993-1.015)	0.454
Reduction of PPG (%)	1.039	(1.007-1.071)	0.017^a	1.050	(1.014-1.087)	0.082
PMA (HU)	0.901	(0.863-0.940)	< 0.001^a	0.930	(0.889-0.974)	0.002^a
TPMT (mm/m)	0.853	(0.774-0.940)	0.001^a	0.895	(0.808-0.992)	0.035^a

^aP < 0.05.

Table 3 The different skeletal muscle abnormalities in patients

Skeletal muscle abnormalities (n = 108)		PMA
Skeletal muscle abnormalities (n = 108)		Low (n = 35); BMI < 25 kg/m²: < 41 HU; BMI ≥ 25 kg/m²: < 33 HU	Normal (n = 73); BMI < 25 kg/m²: ≥ 41 HU; BMI ≥ 25 kg/m²: ≥ 33 HU
TPMT	Low (n = 31); Male: < 10.7 mm/m; Female: < 7.8 mm/m	Sarcopenia; Myosteatosis; (n = 15)	Sarcopenia; No myosteatosis; (n = 14)
TPMT	Normal (n = 77); Male: ≥ 10.7 mm/m; Female: ≥ 7.8 mm/m	Myosteatosis; No sarcopenia; (n = 20)	No myosteatosis; No sarcopenia; (n = 59)

BMI: Body mass index; PMA: Psoas muscle attenuation; TPMT: Transversal psoas muscle thickness; HU: Hounsfield units.

Table 4 The univariate and multivariable analysis results for predicting mortality in patients treated with transjugular intrahepatic portosystemic shunt

Characteristics	Univariate analysis			Multivariate analysis
Characteristics	HR	95%CI	P value	HR	95%CI	P value
Age (years)	1.042	(1.008-1.077)	0.016^a	1.047	(1.012-1.084)	0.278
Gender (male)	1.187	(0.559-2.518)	0.656
BMI (kg/m²)	1.000	(0.871-1.148)	0.997
Etiology (Viral hepatitis/other)	1.187	(0.559-2.518)	0.656
Ascites (yes/no)	1.652	(0.714-3.823)	0.241
Child-Pugh score	1.317	(1.064-1.630)	0.011^a	1.194	(0.903-1.579)	0.740
MELD score	1.089	(1.013-1.172)	0.021^a	1.050	(0.963-1.146)	0.845
NLR	1.060	(0.994-1.130)	0.075
TBIL (umol/L)	1.022	(0.996-1.048)	0.096
ALT (U/L)	1.003	(0.986-1.020)	0.745
AST (U/L)	1.007	(0.998-1.016)	0.109
Reduction in PPG (%)	1.030	(0.992-1.069)	0.120
Albumin (g/L)	0.904	(0.836-0.977)	0.011^a	0.903	(0.827-0.986)	0.023^a
Creatinine (umol/L)	1.012	(1.000-1.024)	0.044^a	1.005	(0.993-1.018)	0.342
PMA (HU)	0.887	(0.839-0.938)	< 0.001^a	0.901	(0.853-0.951)	< 0.001^a
TPMT (mm/m)	0.851	(0.759-0.954)	0.006^a	0.867	(0.760-0.988)	0.032^a

^aP < 0.05.

BMI: Body mass index; MELD: Model for end-stage liver disease; NLR: Neutrophil-lymphocyte ratio; TBIL: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate transaminase; PPG: Portosystemic pressure gradient; PMA: Psoas muscle attenuation; TPMT: Transversal psoas muscle thickness; HU: Hounsfield units.

Citation: Yin L, Chu SL, Lv WF, Zhou CZ, Liu KC, Zhu YJ, Zhang WY, Wang CX, Zhang YH, Lu D, Cheng DL. Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2023; 29(18): 2875-2887
URL: https://www.wjgnet.com/1007-9327/full/v29/i18/2875.htm
DOI: https://dx.doi.org/10.3748/wjg.v29.i18.2875