MELD score, insulin-like growth factor 1 and cytokines on bone density in end-stage liver disease

doi:10.4254/wjh.v3.i6.157

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Jun 27, 2011 (publication date) through Feb 8, 2025

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Jun 27, 2011; 3(6): 157-163
Published online Jun 27, 2011. doi: 10.4254/wjh.v3.i6.157

Table 1 Patient demographics and biochemical data

Variable	n = 117
Age in years	50.4 (10.5)
Male gender - no. (%)	74 (63%)
Etiology of liver disease - no. (%)
Viral	46 (39%)
Alcohol	20 (17%)
Cholestasis	25 (21%)
Other	26 (22%)
BMI (kg/m2)	24.8 (5.0)
Current smoking - no. (%)	43 (37%)
History of fracture - no. (%)	10 (9%)
MELD score	15.2 (6.0)
Calcium^a (N 2.1 - 2.6 ng/L)	2.41 (0.22)
PTH - mean (SD)(N 1.1 - 6.8 ng/L)	2.86 (2.44)
25 OHD (N 40 - 200 μg/mL)	32.2 (19.5)
Total testosterone (N 10 - 29.5 nmol/L)	12.0 (9.9)
IGF-1 (μg /mL) (N, age and sex dependent)	41.3 (54.0)
TNFα (N < 8.1 ng /mL)	14.8 (8.7)
IL-6 (N < 9.7 ng /mL)	17.1 (46.2)
UNTx (N < 81 nmol BCE/ mmol creatinine)	57.3 (36.4)

aCorrected calcium presented; Values are presented as mean (SD) unless indicated otherwise, N: normal range. BCE: bone collagen equivalents; PTH: Parathyroid hormone; BMI: Body mass index; 25OHD: 25-hydroxyvitamin D; IGF-1: Insulin-like growth factor-1; TNFα: Tumor necrosis factor-α; IL-6: Interleukin-6

Table 2 Clinical and Biochemical Data by Etiology of Cirrhosis

Variable	Viral	Alcohol	Cholestasis	Other
Variable	n = 46	n = 20	n = 25	n = 26
BMI (kg/m²)	25.4 (5.1)	24.4 (5.3)	23.3 (3.2)	25.8 (5.9)
MELD score	15.1 (6.14)	16.2 (6.14)	14.2 (5.06)	15.6 (6.51)
Corrected calcium (nmol/L)	2.39 (0.28)	2.44 (0.21)	2.37 (0.11)	2.41 (0.22)
PTH (ng/L)	2.14 (1.2)^a	3.73 (2.7)	2.83 (1.5)	3.48 (3.9)
25OHD (μg/L)	30.6 (16.1)	34.4 (20.1)	37.0 (20.2)	28.7 (17.0)
Testosterone (nmol/L)	12.7 (11.2)	7.0 (4.5)^b	15.7 (7.4)	12.2 (11.5)
IGF-1 (μg/L)	34.5 (47.3)	28.3 (27.1)	45.9 (47.7)	59.5 (79.2)
TNFα (ng/L)	16.1 (10.9)	13.7 (6.7)	15.0 (8.4)	13.0 (5.0)
IL-6 (ng/L)	26.7 (72.4)	19.3 (20.7)	7.1 (5.3)	9.9 (12.2)
UNTx (nmol BCE/mmol creatinine)	54.9 (38.0)	69.3 (25.2)	56.5 (41.6)	53.7 (36.2)

^aPTH significantly lower in viral group than in alcohol and other (P < 0.05);

^bTestosterone significantly lower in alcohol group than in cholestasis (P < 0.05). BCE: bone collagen equivalents; PTH: Parathyroid hormone; BMI: Body mass index; 25OHD: 25-hydroxyvitamin D; IGF-1: Insulin-like growth factor-1; TNFα: Tumor necrosis factor-α; IL-6: Interleukin-6. Values are presented as mean (SD)

Table 3 T-scores and prevalence of abnormal BMD between disease groups

	Viral n = 46	Alcohol n = 20	Cholestasis n = 25	Other n = 26	P value
T-score lumbar spine mean (SD)	-1.08 (1.35)	-1.51 (1.35)	-1.43 (1.23)	-1.30 (1.43)	0.552
T-score femoral neck mean (SD)	-1.11 (1.07)	-1.31 (1.02)	-1.30 (0.81)	-1.03 (1.05)	0.706
Low BMD at 1 or both sites number (%)	31 (67.4%)	13 (65.0%)	18 (72.0%)	18 (69.2%)	0.963
Low BMD lumbar spine number (%)	22 (47.8%)	11 (55.0%)	15 (60.0%)	18 (69.2%)	0.556
Low BMD femoral neck number (%)	26 (56.5%)	12 (60.0%)	15 (60.0%)	14 (53.8%)	0.993

T-score values represent the mean (SD); BMD: Bone marrow density.

Table 4 Correlation between BMD, bone turnover and variables of interest

Variable	T-score(lumbar spine)		T-score(femoral neck)		Urine NTx
	r Value	P Value	r Value	P Value	r Value	P Value
BMI	0.324^a	< 0.001	0.360^a	< 0.001	-0.249^a	0.013
MELD	-0.255^a	0.016	-0.038	0.692	0.311^a	0.002
25OHD	0.278^a	0.016	0.227^a	0.003	-0.426^a	< 0.001
Testosterone (males only)	0.13	0.273	0.003	0.978	-0.377^a	0.003
IGF-1	0.215^a	0.024	0.209^a	0.029	-0.07	0.5
TNFα	-0.139	0.15	-0.084	0.39	0.07	0.51
IL-6	-0.137	0.19	-0.073	0.49	0.276^a	0.015
Urine NTx	-0.346^a	< 0.001	-0.102	0.319

^aSignificant at P < 0.05. BMI: Body mass index; 25OHD: 25-hydroxyvitamin D; IGF-1: Insulin-like growth factor-1; TNFα: Tumor necrosis factor-α; IL-6: Interleukin-6.

Table 5 Clinical and biochemical parameters ranked by severity of bone loss

	Normal	Osteopenia	Osteoporosis	P value
BMI	26.8 (5.1)	24.4 (5.1)^a	22.9 (3.6)^a	0.006
MELD	15.5 (5.9)	14.2 (5.7)	16.9 (6.5)	0.18
25OHD	33.9 (15.7)	33.4 (20.2)	27.9 (15.3)	0.25
Testosterone	11.1 (9.8)	13.7 (10.8)	10.1 (8.3)	0.41
IGF-1	38.3 (35.5)	44.4 (67.5)	39.2 (46.1)	0.86
TNFα	14.3 (10.7)	15.2 (7.6)	14.7 (8.0)	0.89
IL-6	11.8 (12.9)	12.4 (14.0)	15.6 (17.4)	0.64
UNTx	47.2 (27.3)	59.4 (38.7)	70.2 (41.6)^b	0.08

Values are presented as mean (SD);

^aSignificantly lower than in subjects with normal BMD;

^bSignificantly higher than UNTx in subjects with normal BMD (P = 0.027) (Using post-hoc test of ANOVA). BMI: Body mass index; 25OHD: 25-hydroxyvitamin D; IGF-1: Insulin-like growth factor-1; TNFα: Tumor necrosis factor-α; IL-6: Interleukin-6.

Citation: Mitchell R, McDermid J, Ma MM, Chik CL. MELD score, insulin-like growth factor 1 and cytokines on bone density in end-stage liver disease. World J Hepatol 2011; 3(6): 157-163
URL: https://www.wjgnet.com/1948-5182/full/v3/i6/157.htm
DOI: https://dx.doi.org/10.4254/wjh.v3.i6.157