Journal article
Limited performance of subjective global assessment compared to computed tomography-determined sarcopenia in predicting adverse clinical outcomes in patients with cirrhosis.
- Moctezuma-Velazquez C Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
- Ebadi M Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
- Bhanji RA Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
- Stirnimann G Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada; Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
- Tandon P Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
- Montano-Loza AJ Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada. Electronic address: montanol@ualberta.ca.
- 2018-12-15
Published in:
- Clinical nutrition (Edinburgh, Scotland). - 2019
End stage liver disease
Hepatic encephalopathy
Liver transplantation
Muscular atrophy
Nutritional status
Female
Hepatic Encephalopathy
Humans
Hypertension, Portal
Liver Cirrhosis
Liver Transplantation
Male
Middle Aged
Nutrition Assessment
Nutritional Status
Prognosis
Retrospective Studies
Sarcopenia
Tomography, X-Ray Computed
English
BACKGROUND & AIMS
The subjective global assessment (SGA) is commonly used to assess nutritional status in patients with cirrhosis. Sarcopenia, a major component of malnutrition, is associated with survival in cirrhosis, and can be objectively diagnosed by computing the skeletal muscle index (SMI) using cross-sectional imaging. The aim of this study was to assess the prevalence of sarcopenia between SGA categories in patients with cirrhosis, and to determine their association with decompensation/mortality.
METHODS
We included 315 patients (66% males) who were assessed for liver transplantation. All patients had SGA and SMI, and were evaluated for the presence of hepatic encephalopathy (HE) and ascites.
RESULTS
Mean age was 54 ± 8 years. SGA categories were 126 SGA A (40%), 155 SGA B (49%), 34 SGA C (11%). Sarcopenia was present in 121 (38%) patients; of these, 82% were SGA A/B. Of SGA A patients, 25 (20%) had sarcopenia. There was a significant but only weak concordance between sarcopenia and SGA B/C (κ = 0.28, p < 0.001), and SGA C (κ = 0.13, p < 0.001). The latter was lost in overweight/obese patients. SGA B/C was associated with HE (OR 2.8, p = 0.01) and ascites (OR 2.3, p = 0.002). Median survival was shorter in patients with sarcopenia (20 [IQR 15.9-24.5] vs. 42 [IQR: 25.8-58.9] months, p < 0.001) and in SGA C patients (9.4 [IQR: 0-26.2] vs. 33 [IQR 20.2-45.7] months, p = 0.01). In univariate analysis both sarcopenia and SGA C were associated with mortality, but sarcopenia was the only factor that remained significant on multivariate analysis.
CONCLUSIONS
There was only a weak concordance between SGA and sarcopenia. This concordance was non-significant in patients who were overweight/obese. Sarcopenia was associated with mortality, whereas SGA was not. Sarcopenia by the SMI is a more efficient method to predict adverse outcomes in a timely fashion and has prognostic implications.
The subjective global assessment (SGA) is commonly used to assess nutritional status in patients with cirrhosis. Sarcopenia, a major component of malnutrition, is associated with survival in cirrhosis, and can be objectively diagnosed by computing the skeletal muscle index (SMI) using cross-sectional imaging. The aim of this study was to assess the prevalence of sarcopenia between SGA categories in patients with cirrhosis, and to determine their association with decompensation/mortality.
METHODS
We included 315 patients (66% males) who were assessed for liver transplantation. All patients had SGA and SMI, and were evaluated for the presence of hepatic encephalopathy (HE) and ascites.
RESULTS
Mean age was 54 ± 8 years. SGA categories were 126 SGA A (40%), 155 SGA B (49%), 34 SGA C (11%). Sarcopenia was present in 121 (38%) patients; of these, 82% were SGA A/B. Of SGA A patients, 25 (20%) had sarcopenia. There was a significant but only weak concordance between sarcopenia and SGA B/C (κ = 0.28, p < 0.001), and SGA C (κ = 0.13, p < 0.001). The latter was lost in overweight/obese patients. SGA B/C was associated with HE (OR 2.8, p = 0.01) and ascites (OR 2.3, p = 0.002). Median survival was shorter in patients with sarcopenia (20 [IQR 15.9-24.5] vs. 42 [IQR: 25.8-58.9] months, p < 0.001) and in SGA C patients (9.4 [IQR: 0-26.2] vs. 33 [IQR 20.2-45.7] months, p = 0.01). In univariate analysis both sarcopenia and SGA C were associated with mortality, but sarcopenia was the only factor that remained significant on multivariate analysis.
CONCLUSIONS
There was only a weak concordance between SGA and sarcopenia. This concordance was non-significant in patients who were overweight/obese. Sarcopenia was associated with mortality, whereas SGA was not. Sarcopenia by the SMI is a more efficient method to predict adverse outcomes in a timely fashion and has prognostic implications.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.clnu.2018.11.024
- PMID 30545661
- Persistent URL
- https://folia.unifr.ch/global/documents/122266
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