A multicenter study to define sarcopenia in patients with end-stage liver disease

Elizabeth J. Carey, Jennifer C. Lai, Connie W. Wang, Srinivasan Dasarathy, Iryna Lobach, Aldo J. Montano-Loza, Michael A. Dunn, for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium

Research output: Contribution to journalArticle

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Abstract

Sarcopenia is associated with increased wait-list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98%. Using image analysis software, the total cross-sectional area (cm2) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait-list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex-specific potential cutoff values to define sarcopenia were determined with a grid search guided by log-rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2/m2: 50.0 in men and 42.0 in women. At a median of 8.8 months follow-up, mortality was 25% in men and 36% in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2/m2; P < 0.001), and SMI was associated with wait-list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2/m2 for men and < 39 cm2/m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625–633 2017 AASLD.

Original languageEnglish (US)
Pages (from-to)625-633
Number of pages9
JournalLiver Transplantation
Volume23
Issue number5
DOIs
StatePublished - May 1 2017

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Sarcopenia
End Stage Liver Disease
Multicenter Studies
Skeletal Muscle
Liver Transplantation
Waiting Lists
Mortality
Abdominal Muscles
Lumbar Vertebrae
Survival
Software
Retrospective Studies
Tomography
Transplants
Muscles

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Carey, E. J., Lai, J. C., Wang, C. W., Dasarathy, S., Lobach, I., Montano-Loza, A. J., ... for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium (2017). A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transplantation, 23(5), 625-633. https://doi.org/10.1002/lt.24750

A multicenter study to define sarcopenia in patients with end-stage liver disease. / Carey, Elizabeth J.; Lai, Jennifer C.; Wang, Connie W.; Dasarathy, Srinivasan; Lobach, Iryna; Montano-Loza, Aldo J.; Dunn, Michael A.; for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium.

In: Liver Transplantation, Vol. 23, No. 5, 01.05.2017, p. 625-633.

Research output: Contribution to journalArticle

Carey, EJ, Lai, JC, Wang, CW, Dasarathy, S, Lobach, I, Montano-Loza, AJ, Dunn, MA & for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium 2017, 'A multicenter study to define sarcopenia in patients with end-stage liver disease', Liver Transplantation, vol. 23, no. 5, pp. 625-633. https://doi.org/10.1002/lt.24750
Carey EJ, Lai JC, Wang CW, Dasarathy S, Lobach I, Montano-Loza AJ et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transplantation. 2017 May 1;23(5):625-633. https://doi.org/10.1002/lt.24750
Carey, Elizabeth J. ; Lai, Jennifer C. ; Wang, Connie W. ; Dasarathy, Srinivasan ; Lobach, Iryna ; Montano-Loza, Aldo J. ; Dunn, Michael A. ; for the Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium. / A multicenter study to define sarcopenia in patients with end-stage liver disease. In: Liver Transplantation. 2017 ; Vol. 23, No. 5. pp. 625-633.
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abstract = "Sarcopenia is associated with increased wait-list mortality, but a standard definition is lacking. In this retrospective study, we sought to determine the optimal definition of sarcopenia in end-stage liver disease (ESLD) patients awaiting liver transplantation (LT). Included were 396 patients newly listed for LT in 2012 at 5 North American transplant centers. All computed tomography scans were read by 2 individuals with interobserver correlation of 98{\%}. Using image analysis software, the total cross-sectional area (cm2) of abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI), which normalizes muscle area to patient height, was then calculated. The primary outcome was wait-list mortality, defined as death on the waiting list or removal from the waiting list for reasons of clinical deterioration. Sex-specific potential cutoff values to define sarcopenia were determined with a grid search guided by log-rank test statistics. Optimal search methods identified potential cutoffs to detect survival differences between groups. The overall median SMI was 47.6 cm2/m2: 50.0 in men and 42.0 in women. At a median of 8.8 months follow-up, mortality was 25{\%} in men and 36{\%} in women. Patients who died had lower SMI than those who survived (45.6 versus 48.5 cm2/m2; P < 0.001), and SMI was associated with wait-list mortality (hazard ratio, 0.95; P < 0.001). Optimal search method yielded SMI cutoffs of 50 cm2/m2 for men and 39 cm2/m2 for women; these cutoff values best combined statistical significance with a sufficient number of events to detect survival differences between groups. In conclusion, we recommend that an SMI < 50 cm2/m2 for men and < 39 cm2/m2 for women be used to define sarcopenia in patients with ESLD awaiting LT. Liver Transplantation 23 625–633 2017 AASLD.",
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