Refining dual-energy x-ray absorptiometry data to predict mortality among cirrhotic outpatients: A retrospective study

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 85; p. 111132
• Main Authors: Santos, Lívia Alves Amaral, Lima, Talles Bazeia, Qi, Xingshun, Paiva, Sérgio Alberto Rupp de, Romeiro, Fernando Gomes
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2021; Elsevier Limited
• Subjects: Age; Ascites; Cirrhosis; Dual energy X-ray absorptiometry; Edema; Health risks; Liver; Liver cirrhosis; Liver diseases; Liver transplants; Medical waiting lists; Mortality; Mortality risk; Muscles; Patients; Retention; Sarcopenia; Software; Statistical analysis; Variables; X-rays; United States > US; Sarcopenia; Edema; Dual-energy x-ray absorptiometry; Ascites; Liver cirrhosis; Mortality
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2020.111132

The aim of this study was to compare the effects of muscle wasting according to measures obtained by different limb muscle mass indexes, to find the best mortality predictor among outpatients with cirrhosis.
Patients with liver cirrhosis (N = 210) were submitted to dual-energy x-ray absorptiometry (DXA). Appendicular muscle mass (AMM), AMM index (AMMI), upper limb muscle mass (ULMM), and ULMM index (ULMMI) were calculated. The Model for End-Stage Liver Disease, anthropometric measures, and the presence of ascites and edema were also registered. Multiple logistic regressions were performed to determine mortality predictors; the area under the receiver operating characteristic curve was used to establish the best cutoff point to predict mortality.
The mean follow-up duration was 49 ± 15.59 mo. ULMM and ULMMI were clearly associated with mortality (P = 0.007 and 0.001, respectively), whereas AMM and AMMI were not. After calculating the cutoff points for men and women, the presence of a depleted ULMMI as a categorical variable was associated with a mortality risk 2.5 times higher.
The results suggest that using ULMMI is better than AMMI for predicting mortality of outpatients with cirrhosis, thus offering a better measure to detect muscle wasting in this population using DXA.
•Muscle loss is a severe complication of liver cirrhosis.•Dual-energy x-ray absorptiometry is used to measure the muscle bulk of limbs.•Ascites and edema can impair the accuracy of the values obtained.•The relevance of dual-energy x-ray absorptiometry for such patients was confirmed.•Results suggest that muscle wasting can be diagnosed early in these patients.•A new measure is proposed to quantify muscle wasting in cirrhotic patients.•Upper limb muscle mass index was the best predictor of mortality in this setting.