评估肌肉疏松症有助于预测老年肝硬化患者的 TIPS 后死亡率

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.031

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引用次数: 0

摘要

背景和目的经颈静脉肝内门体分流术（TIPS）已被证明对老年患者（年龄≥70 岁）可行，但选择标准仍不理想。肌肉疏松症在老年人群中非常普遍，可能与 TIPS 术后结果有很大关系。本研究旨在评估基线肌肉疏松症对老年肝硬化患者TIPS术后存活率的影响。方法对意大利前瞻性TIPS-Registry进行回顾性分析，以确定2015年6月至2023年3月期间接受TIPS治疗的年龄≥70岁的患者。基线腹部 CT 扫描是强制性纳入标准。骨骼肌指数（SMI）在 L3-L4 水平进行评估。男性的骨骼肌指数为 50 cm2/m2，女性为 39 cm2/m2。与肝脏相关的死亡概率通过竞争风险分析进行评估。结果共纳入 115 名患者：中位年龄 74 岁（IQR 3.1），62% 为男性，中位干体重指数 25.7（IQR 4.7），60% 患有肌肉疏松症。主要病因是病毒（40%）、酒精相关性肝硬化（23%）和代谢功能障碍相关性脂肪性肝炎（20%）。难治性腹水（57%）是 TIPS 的主要适应症。在平均 20 个月（IQR 20）的随访期间，40 名（34.8%）患者死于肝脏相关原因，16 名（13.9%）患者死于肝外原因。肌肉疏松症患者的肝脏相关死亡率明显高于非肌肉疏松症患者（6 个月：25.0% 对 2.9%）：6个月：25.0% 对 2.2%；1年：43.0% 对 4.9%）：分别为 43.0% 对 4.8%；P 值为 0.001）。我们建立了一个包括 INR、肌酐和肌肉疏松症的预测模型来估算与肝脏相关的死亡率。该模型具有良好的预测性能，6 个月、1 年和 2 年的 AUC 分别为 0.826、0.788 和 0.712。TIPS 术后肝脏相关死亡率的新预测模型值得外部验证。

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Assessment of sarcopenia improves the prediction of post-TIPS mortality in older adult patients with cirrhosis

Background and Aims

Transjugular intrahepatic portosystemic shunt (TIPS) has been demonstrated to be feasible in older adult patients (age ≥70 years), yet the selection criteria remain suboptimal. Sarcopenia, highly prevalent in elderly population, may be significantly associated with post-TIPS outcome. This study aimed at evaluating the impact of baseline sarcopenia on post-TIPS survival in older adults with cirrhosis.

Method

A retrospective analysis of the prospective Italian TIPS-Registry was conducted to identify patients ≥70 years who received TIPS from June 2015 to March 2023. The availability of baseline abdominal CT scan was a mandatory inclusion criterion. Skeletal muscle index (SMI) was evaluated at the L3-L4 level. Sarcopenia was defined as SMI <50 cm²/m² for men and <39 cm²/m² for women. Probability of liver-related death was evaluated by competing risks analysis. A prediction model for liver-related mortality was created.

Results

One-hundred and fifteen patients were included: median age 74 years (IQR 3.1), 62% male, median dry-BMI 25.7 (IQR 4.7), 60% prevalence of sarcopenia. The main etiologies were viral (40%), alcohol-associated cirrhosis (23%), and metabolic dysfunction-associated steatohepatitis (20%). Refractory ascites (57%) was the main indications for TIPS. During a mean follow up of 20 months (IQR 20), 40 (34.8%) patients died for liver-related causes and 16 (13.9%) for extrahepatic causes. Liver-related mortality was significantly higher in patients with sarcopenia than in those without (6-months: 25.0% vs. 2.2%; 1-year: 43.0% vs. 4.8%, respectively; p value <0.001). A predictive model including INR, creatinine, and sarcopenia was developed to estimate liver-related mortality. The model achieved good predictive performances with AUCs of 0.826, 0.788, and 0.712 at 6-month, 1-year, and 2-years, respectively.

Conclusion

Due to its significant impact on survival, the evaluation of sarcopenia may improve the selection of older adults candidate to TIPS. The new predictive model for post-TIPS liver-related mortality deserves external validation.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.