Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2023; 29(18): 2875-2887
Published online May 14, 2023. doi: 10.3748/wjg.v29.i18.2875
Contributory roles of sarcopenia and myosteatosis in development of overt hepatic encephalopathy and mortality after transjugular intrahepatic portosystemic shunt
Liang Yin, Sen-Lin Chu, Wei-Fu Lv, Chun-Ze Zhou, Kai-Cai Liu, Yi-Jiang Zhu, Wen-Yue Zhang, Cui-Xia Wang, Yong-Hui Zhang, Dong Lu, De-Lei Cheng
Liang Yin, Sen-Lin Chu, Wei-Fu Lv, Chun-Ze Zhou, Yi-Jiang Zhu, Wen-Yue Zhang, Cui-Xia Wang, Yong-Hui Zhang, Dong Lu, De-Lei Cheng, Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230022, Anhui Province, China
Kai-Cai Liu, Infection Hospital, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
Author contributions: Yin L and Chu SL designed the research, analyzed the data, and wrote the initial draft of the manuscript; Zhou CZ, Liu KC, Zhu YJ and Lu D collected the data, analyzed the data, and designed the study; Zhang WY, Wang CX and Zhang YH performed the research and collected the data; Lv WF and Cheng DL contributed to the central idea, designed the study, and wrote the manuscript.
Supported by Natural Science Foundation of Anhui Province, No. 2108085MH301; and The Key Project of University Research Found of Anhui Province Education Department, No. 2022AH040189.
Institutional review board statement: The retrospective study protocol was approved by the institutional review board of The First Affiliated Hospital of University of Science and Technology of China, No. 2022-RE-461.
Informed consent statement: Informed consent for the study was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed in the study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: De-Lei Cheng, MD, Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei 230022, Anhui Province, China. 39055004@qq.com
Received: January 29, 2023
Peer-review started: January 29, 2023
First decision: February 22, 2023
Revised: March 8, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: May 14, 2023
Processing time: 101 Days and 23 Hours
Abstract
BACKGROUND

Skeletal muscle abnormalities, such as muscle mass depletion (sarcopenia) and fatty infiltration of the muscle (myosteatosis), are frequent complications in cirrhotic patients scheduled for transjugular intrahepatic portosystemic shunt (TIPS).

AIM

To investigate the association and predictive value of sarcopenia and myosteatosis for overt hepatic encephalopathy (HE) and mortality after TIPS.

METHODS

The records of cirrhotic patients who underwent the TIPS procedure at our hospital between January 2020 and June 2021 were retrospectively retrieved. The transversal psoas muscle thickness (TPMT) and psoas muscle attenuation (PMA) measured from the unenhanced abdominal computed tomography (CT) at the level of the third lumbar vertebrae were used to analyze the sarcopenia and myosteatosis, respectively. The area under curve (AUC) was used to evaluate the discriminative power of TPMT, PMA, and relevant clinical parameters. Fur-thermore, log-rank test was performed to compare the incidence of overt HE and survival between the different groups, and the association of risk factors with overt HE and mortality was analyzed using Cox proportional hazards regression models.

RESULTS

A total of 108 patients were collected. Among these patients, 45.4% of patients developed overt HE after TIPS treatment. Furthermore, 32.4% and 28.7% of these patients were identified to have myosteatosis and sarcopenia, respectively. Myosteatosis (51.0% vs 16.9%, P < 0.001) and sarcopenia (40.8 vs 18.6%, P = 0.011) were found to be more frequent in patients with overt HE, when compared to patients without overt HE. The receiver operating characteristics analysis indicated that the predictive power of TPMT and PMA in overt HE (AUC = 0.713 and 0.778, respectively) was higher when compared to the neutrophil lymphocyte ratio (AUC = 0.636). The cumulative incidence of overt HE was the highest in patients with concomitant sarcopenia and myosteatosis, followed by patients with myosteatosis or sarcopenia, while this was the lowest in patients without sarcopenia and myosteatosis. In addition, sarcopenia and myosteatosis were inde-pendently associated with overt HE and mortality after adjusting for confounding factors in post-TIPS patients.

CONCLUSION

CT-based estimations for sarcopenia and myosteatosis can be used as reliable predictors for the risk of developing overt HE and mortality in cirrhotic patients after TIPS.

Keywords: Sarcopenia; Myosteatosis; Hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt; Transjugular intrahepatic portosystemic shunt

Core Tip: Few studies have investigated the relationship among sarcopenia, myosteatosis, and overt hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS). The present study revealed that the cumulative incidence of overt HE was the highest in patients with concomitant sarcopenia and myosteatosis, followed by patients with myosteatosis or sarcopenia, and the lowest incidence was found in patients without myosteatosis and sarcopenia. Sarcopenia and myosteatosis were the independent risk factors for overt HE and mortality in patients following TIPS. Therefore, identifying strategies for improving muscle mass (sarcopenia) and muscle fatty infiltration (myosteatosis) may help to reduce the incidence of HE after TIPS.