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Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis
Copyright policy ) Xinxing Tantai; Yi Liu; Yee Hui Yeo; Michael Praktiknjo; Ezequiel Mauro; Yuhei Hamaguchi; Cornelius Engelmann; +25 Authors
Xinxing Tantai; Yi Liu; Yee Hui Yeo; Michael Praktiknjo; Ezequiel Mauro; Yuhei Hamaguchi; Cornelius Engelmann; Peng Zhang; Jae Yoon Jeong; Jeroen L.A. van Vugt; Huijuan Xiao; Huan Deng; Xu Gao; Qing Ye; Jiayuan Zhang; Longbao Yang; Ya-Qin Cai; Yi-Xin Liu; Na Liu; Zongfang Li; Tao Han; Toshimi Kaido; Joo Hyun Sohn; Christian P. Strassburg; Thomas Berg; Jonel Trebicka; Yao-Chun Hsu; Jan N. M. IJzermans; Jinhai Wang; Grace L. Su; Fanpu Ji; Mindie H. Nguyen;
Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis
BACKGROUND & AIMS: The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, we aimed to quantify the association between sarcopenia and the risk of mortality in patients with cirrhosis, stratified by sex, underlying liver disease etiology, and severity of hepatic dysfunction.METHODS: PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restriction through 13 January 2021 with an additional manual search of bibliographies of relevant articles. Cohort studies of ≥100 patients with cirrhosis and ≥12 months of follow-up that evaluated the association between sarcopenia, muscle mass and the risk of mortality were included.RESULTS: Twenty-two studies involving 6,965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% CI 32.4%-42.8%), and was higher in male patients, those with alcohol-associated liver disease, those with Child-Pugh grade C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index). Sarcopenia was associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratio [aHR] 2.30, 95% CI 2.01-2.63), with similar findings in a sensitivity analysis of patients with cirrhosis without hepatocellular carcinoma (aHR 2.35, 95% CI 1.95-2.83) and in subgroups stratified by sex, liver disease etiology, and severity of hepatic dysfunction. The association between quantitative muscle mass index and mortality further supports the association between sarcopenia and poor prognosis (aHR 0.95, 95% CI 0.93-0.98). There was no significant heterogeneity in any of our analyses.CONCLUSIONS: Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis.LAY SUMMARY: The prevalence of sarcopenia and its association with death in patients with cirrhosis remain unclear. This meta-analysis indicated that sarcopenia affected about one-third of patients with cirrhosis and up to 50% of patients with alcohol-related liver disease or Child-Pugh class C cirrhosis. Sarcopenia was independently associated with an ∼2-fold higher risk of mortality in patients with cirrhosis. The mortality rate increased with greater severity or longer durations of sarcopenia. Increasing awareness about the importance of sarcopenia in patients with cirrhosis among stakeholders must be prioritized.
Netherlands, Spain, Denmark
- I-Shou University Taiwan
- Xi'an Jiaotong University China (People's Republic of)
- Hanyang University Korea (Republic of)
- Fu Jen Catholic University Taiwan
- Erasmus University Rotterdam Netherlands
Microsoft Academic Graph classification: medicine.medical_specialty Cirrhosis medicine.medical_treatment Liver transplantation Liver disease Model for End-Stage Liver Disease Internal medicine medicine Risk of mortality business.industry Mortality rate medicine.disease Newcastle–Ottawa scale Sarcopenia business
Medical Subject Headings: musculoskeletal system human activities
Liver Cirrhosis, Sarcopenia, Cirrosi hepàtica, sarcopenia, Liver Cirrhosis/complications, Muscular Diseases, Risk Factors, Humans, skeletal muscle index, Malalties musculars, Hepatology, cirrhosis, Prognosis, alcohol-associated liver disease, Survival Analysis, Hepatic cirrhosis, Sarcopenia/complications, prognosis
Liver Cirrhosis, Sarcopenia, Cirrosi hepàtica, sarcopenia, Liver Cirrhosis/complications, Muscular Diseases, Risk Factors, Humans, skeletal muscle index, Malalties musculars, Hepatology, cirrhosis, Prognosis, alcohol-associated liver disease, Survival Analysis, Hepatic cirrhosis, Sarcopenia/complications, prognosis
Microsoft Academic Graph classification: medicine.medical_specialty Cirrhosis medicine.medical_treatment Liver transplantation Liver disease Model for End-Stage Liver Disease Internal medicine medicine Risk of mortality business.industry Mortality rate medicine.disease Newcastle–Ottawa scale Sarcopenia business
Medical Subject Headings: musculoskeletal system human activities
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).84 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 1% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 10% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1% views 97 downloads 61 citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).84 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 1% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 10% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1% - 97views61downloads
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This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
Citations provided by BIP!popularityPopularity provided by BIP!
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
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This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
Influence provided by BIP!impulseImpulse provided by BIP!
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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Related to Research communities
- I-Shou University Taiwan
- Xi'an Jiaotong University China (People's Republic of)
- Hanyang University Korea (Republic of)
- Fu Jen Catholic University Taiwan
- Erasmus University Rotterdam Netherlands
- Cedars-Sinai Medical Center United States
- University of Michigan–Flint United States
- University of Barcelona Spain
- Leipzig University Germany
- University of Southern Denmark Denmark
- University Hospital Bonn Germany
- Stanford University United States
- Charité - University Medicine Berlin Germany
- University of London United Kingdom
- Erasmus University Rotterdam Netherlands
BACKGROUND & AIMS: The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, we aimed to quantify the association between sarcopenia and the risk of mortality in patients with cirrhosis, stratified by sex, underlying liver disease etiology, and severity of hepatic dysfunction.METHODS: PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restriction through 13 January 2021 with an additional manual search of bibliographies of relevant articles. Cohort studies of ≥100 patients with cirrhosis and ≥12 months of follow-up that evaluated the association between sarcopenia, muscle mass and the risk of mortality were included.RESULTS: Twenty-two studies involving 6,965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% CI 32.4%-42.8%), and was higher in male patients, those with alcohol-associated liver disease, those with Child-Pugh grade C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index). Sarcopenia was associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratio [aHR] 2.30, 95% CI 2.01-2.63), with similar findings in a sensitivity analysis of patients with cirrhosis without hepatocellular carcinoma (aHR 2.35, 95% CI 1.95-2.83) and in subgroups stratified by sex, liver disease etiology, and severity of hepatic dysfunction. The association between quantitative muscle mass index and mortality further supports the association between sarcopenia and poor prognosis (aHR 0.95, 95% CI 0.93-0.98). There was no significant heterogeneity in any of our analyses.CONCLUSIONS: Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis.LAY SUMMARY: The prevalence of sarcopenia and its association with death in patients with cirrhosis remain unclear. This meta-analysis indicated that sarcopenia affected about one-third of patients with cirrhosis and up to 50% of patients with alcohol-related liver disease or Child-Pugh class C cirrhosis. Sarcopenia was independently associated with an ∼2-fold higher risk of mortality in patients with cirrhosis. The mortality rate increased with greater severity or longer durations of sarcopenia. Increasing awareness about the importance of sarcopenia in patients with cirrhosis among stakeholders must be prioritized.