Measurement of skeletal muscle volume is useful for predicting prognosis in patients with liver cirrhosis

Background Hepatic venous pressure gradient (HVPG) and the model for end-stage liver disease (MELD) score were previously reported as prognostic factors for outcome in patients with liver cirrhosis (LC), and recently, the presence of sarcopenia was reported to be an indicator of worse prognosis in these patients. Aim This retrospective study aimed to clarify the importance of sarcopenia as a prognostic factor in patients with LC. Material and methods The MELD-Na score, HVPG, and skeletal muscle index (SMI) were measured in 202 patients between January 2013 and August 2020. We performed linear regression analysis between HVPG and SMI and calculated suitable cutoff values of HVPG for predicting presarcopenia and of HVPG, Delta SMI (i.e. the decrease in SMI per year, for predicting survival). Overall survival rates with the HVPG and Delta SMI cutoff values were compared by Kaplan-Meier estimates and log-rank tests. Prognostic factors for survival were analyzed by Cox regression univariate and multivariate analyses. Results In total, 71% (143/202) of patients presented with presarcopenia. Linear regression showed a significantly negative correlation between HVPG and SMI. Survival was significantly worse in the group with presarcopenia than in the group without. Survival was worse also in the group with an HVPG value >= 15 and Delta SMI >= -2.4. Cox regression multivariate analyses showed that MELD-Na score, HVPG, HVPG >= 15, Delta SMI, and Delta SMI >= -2.4 were independent prognostic factors. Conclusion Skeletal muscle volume, especially Delta SMI, has a prognostic value equivalent to that of the MELD-Na score and HVPG.