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
ARTICLE HIGHLIGHTS
Research 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 a transjugular intrahepatic portosystemic shunt (TIPS) procedure, leading to an incidence of approximately 20%-50% for overt hepatic encephalopathy (HE).

Research motivation

The motivation of the study was to provide computed tomography (CT) image-based methods for predicting overt HE and mortality after TIPS, based on the sarcopenia and myosteatosis.

Research objectives

The study aims to investigate the association and predictive volubility of sarcopenia and myosteatosis for overt HE, and mortality after TIPS.

Research methods

The records of cirrhotic patients, who underwent the TIPS procedure at our hospital, were retrospectively reviewed. Transversal psoas muscle thickness and psoas muscle attenuation, which were measured by unenhanced abdominal CT at the level of the third lumbar vertebrae, were used to diagnose the sarcopenia and myosteatosis, respectively. Then, the incidence of overt HE and mortality were compared based on the sarcopenia and myosteatosis status.

Research results

A total of 108 patients were collected. Myosteatosis (51.0% vs 16.9%, P < 0.001) and sarcopenia (40.8 vs 18.6%, P = 0.011) were identified to be more frequent in patients with overt HE, when compared to patients without overt HE. 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 independently associated with overt HE and mortality after adjusting for confounding factors in post-TIPS patients.

Research conclusions

The CT-based diagnostic method of sarcopenia and myosteatosis can be used as a reliable predictor for the risk of developing overt HE and mortality in cirrhotic patients after TIPS.

Research perspectives

In the future, more well-designated trials are required to standardize the CT-derived diagnostic criteria for sarcopenia and myosteatosis. In addition, more validation studies are needed to confirm the predictivities of sarcopenia and myosteatosis in post-TIPS overt HE.