Sarcopenia—A Valuable Imaging Biomarker for Disease Progression in Patients With Primary Sclerosing Cholangitis (PSC)?

Background and Aims

We aimed to ascertain the prevalence of sarcopenia in patients with primary sclerosing cholangitis (PSC) and to assess the prognostic value as a biomarker for disease outcome.

Methods

We collected data from 224 patients (148 male, 76 female; mean age 41 years) from January 2002 to December 2021, with a confirmed diagnosis of PSC who underwent magnetic resonance imaging (MRI). Muscle mass was quantified at the level of the third lumbar vertebra by measurement of psoas muscle thickness (PMT) and total psoas muscle area (PMA). Sarcopenia was defined according to previously published cut-off values. Muscle mass and the prevalence of sarcopenia were correlated with patient and disease characteristics, prognostic scoring systems (model for end-stage liver disease (MELD) score; Mayo Risk Score; Amsterdam-Oxford PSC Score) and clinical endpoints (liver transplantation, cirrhosis decompensation, liver-related death).

Results

Seventy-eight patients reached a total of 104 clinical endpoints (liver transplantation n = 57, cirrhosis decompensation n = 28, liver-related death n = 19). Sarcopenia was prevalent in 27.7% and 51.3%, respectively (according to the definition of PMT and PMA). Sarcopenia was significantly more prevalent in female patients and in patients without IBD (p < 0.05). A slight but significant negative correlation of muscle mass was noticed with the MELD (r = −0.244, p = 0.001) and Mayo Risk Score (r = −0.13, p = 0.046). At follow-up, sarcopenia was associated with an inferior liver-related event-free survival (p < 0.05).

Conclusions

Sarcopenia is highly prevalent in a large PSC cohort from a tertiary care centre, even more frequent in female patients and in patients without concomitant IBD. Furthermore, the presence of sarcopenia in PSC patients is associated with an inferior liver-related event-free survival.