Among patients with cirrhosis, muscle volume loss and hepatocellular carcinoma within Milan criteria were prognostic factors for mortality, according to recently published data.
As many patients with cirrhosis have protein-calorie malnutrition, the researchers advise that improving protein catabolism and lipolysis with a “late night snack” and combined in-hospital exercise with consumption of branched chain amino acids can minimize skeletal muscle atrophy.
“Recent progress in anti-viral therapy, such as direct-acting antivirals, and nucleos(t)ide analogues, has made prevention of [chronic liver disease (CLD)] progression possible, though issues related to muscle wasting in CLD patients remain,” the researchers wrote. “Establishment of an effective strategy for treating progression of [muscle volume loss] and reduced muscle strength in CLD patients will be needed.”
The researchers enrolled 346 patients with cirrhosis who underwent upper gastrointestinal endoscopy and CT. Researchers matched 1:1 patients with portal hypertension (PHT) and those without according to age, sex, and clinical demographics.
Patients with muscle volume loss in the PHT group had a significantly lower rate of overall survival compared with patients without muscle loss in both the PHT group (P = .017) and the group without PHT (P = .012).
Overall, patients with muscle volume loss had lower 1-year (89.1% vs. 98.1%; P < .001), 3-year (69% vs. 98.1%; P < .001) and 5-year (35.8% vs. 74.1%; P < .001) survival rates than those without muscle volume loss. This remained significant after the researchers excluded patients with HCC at 1 year (85.9% vs 98.9; P < .0014), 3 years (72.8% vs. 93.5%; P < .0014) and 5 years (72.8% vs. 86.4%; P = .0014).
After multivariate analysis, muscle volume loss (HR = 2.797; 95% CI, 1.601-4.885) and HCC within Milan criteria (HR = 2.028; 95% CI, 1.189-3.46) predicted worse mortality outcomes.
“Although the cause of death in patients without [muscle volume loss] was digestive bleeding in three and unknown in five, the frequency of death from other organ complications was greater in those with [muscle volume loss],” the researchers concluded. “Additional analyses will be needed to elucidate the role of [muscle volume loss] in the clinical course of CLD patients, especially those with PHT.” – by Talitha Bennett
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