Elsevier

Nutrition

Volume 42, October 2017, Pages 87-91
Nutrition

Applied nutritional investigation
Low skeletal muscle mass predicts early mortality in cirrhotic patients with acute variceal bleeding

https://doi.org/10.1016/j.nut.2017.06.004Get rights and content

Highlights

  • The 5-d rebleeding and mortality was unrelated to the presence of low muscle mass.

  • The 6-wk mortality was significantly higher in patients with low muscle mass.

  • Liver failure was the main cause of death in patients with low muscle mass.

Abstract

Objectives

Low skeletal muscle mass adversely affects outcomes in cirrhotic patients; however, its affect in patients with acute variceal bleeding remains unknown. The aim of this study was to evaluate the effects of low skeletal muscle mass on outcomes in patients with cirrhosis and acute variceal bleeding.

Methods

We evaluated 122 patients to identify factors associated with two outcomes: failure to control bleeding, defined as either rebleeding or death within 5 d, and 6-wk mortality. Skeletal muscle mass was estimated by calculating the psoas muscle area at the third lumbar vertebra on computed tomographic images.

Results

Forty-two patients had low skeletal muscle mass. Fifteen patients had failure to control bleeding and 32 patients died within 6 wk. Six of the patients with low skeletal muscle mass and nine without low skeletal muscle mass had failure to control bleeding; these proportions did not differ significantly (P = 0.628). Fifteen of the patients (35.7%) with low skeletal muscle mass died within 6 wk; this proportion was marginally higher than the 17 (21.3%) without low skeletal muscle mass who died within 6 wk (P = 0.084). On multivariate analysis, presence of low skeletal muscle mass (odds ratio [OR], 4.69; P = 0.024), nonalcoholic etiology (OR, 10.3; P = 0.024), higher international normalized ratio of prothrombin time (OR, 41.4; P < 0.001), and rebleeding within 6 wk (OR, 27; P < 0.001) were associated with 6-wk mortality.

Conclusions

Low skeletal muscle mass is an independent predictor of 6-wk mortality in cirrhotic patients with acute variceal bleeding.

Introduction

Acute variceal bleeding (AVB) is a fatal complication in patients with cirrhosis. Although the introduction of endoscopic band ligation (EBL) has improved the outcomes of such patients, the mortality rate is still about 20% [1]. A further reduction in mortality would require the identification and more aggressive treatment of patients at high risk for early mortality [2].

In patients with cirrhosis, malnutrition, which is caused by poor dietary intake, malabsorption, low protein synthesis, and hypermetabolism, is often seen [3] and represented by decreased skeletal muscle mass [4]. Recently, low skeletal muscle mass, seen in an approximately half of all patients with cirrhosis [5], was shown to be a predictor of mortality in cirrhotic patients under several conditions, such as waiting for liver transplantation, post-liver transplantation [5], and bearing hepatocellular carcinoma [6], however, the influence of low skeletal muscle mass on cirrhotic patients with AVB remains unclear.

We studied the effects of low skeletal muscle mass on the outcomes of cirrhotic patients with AVB treated by endoscopic treatment to attempt to identify high-risk patients.

Section snippets

Patients

We evaluated 169 patients with cirrhosis who underwent EBL for acute gastroesophageal variceal bleeding in our department between April 2003 and April 2016. Of these patients, 47 were excluded because they dropped out within 6 wk after endoscopic treatment, had incomplete laboratory test data, did not undergo computed tomography (CT) examinations, or had a history of ABV within the past 6 wk. The remaining 122 patients were studied. Baseline characteristics are shown in Table 1. The causes of

Prevalence of low skeletal muscle mass in cirrhotic patients with AVB

The prevalence of low skeletal muscle mass was 34.4% (42 of 122 patients) in cirrhotic patients with AVB. The prevalence of low skeletal muscle mass according to the MELD score was 29.2% (7 of 24 patients) in patients with a score of <10, 35.6% (16 of 45 patients) in patients with a score of 10 to 14, and 35.8% (19 of 53 patients) in patients with a score of ≥15. These prevalences did not differ significantly (P = 0.832). Normalized skeletal muscle area (cm2/m2) also did not differ according to

Discussion

This study showed that low skeletal muscle mass is one of the significant independent predictors of 6-wk mortality in cirrhotic patients who have AVB after ELT.

Despite recent advances in treatment for AVB enabled by the development of pharmacologic and band ligation therapy, approximately one in five patients died within 6 wk. More aggressive therapy, such as early TIPS, might improve the outcomes of these patients [13]; however, the implementation of such therapy in all hospitals around the

Conclusion

The presence of a low skeletal muscle mass is significantly and independently related to increased 6-wk mortality among cirrhotic patients with ABV treated by EBL. Further prospective studies are needed to confirm our results.

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  • Cited by (0)

    YI and MI were involved in the conception and design of the study, as well as the drafting and revision of the manuscript. All authors participated in the generation, collection, assembly, analysis, and interpretation of the data and read and approved the final version of the manuscript.

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