A182 SIX-MINUTE WALK TEST AND SARCOPENIA IN PREDICTING MORTALITY IN PATIENTS WITH CIRRHOSIS

Low muscle mass (sarcopenia) is associated with increased mortality in patients with cirrhosis. The association of functional performance with sarcopenia and its impact on mortality has not been well established in cirrhosis. 1) Determine the association of functional performance assessed by the six-minute walk test (6MWT) and sarcopenia 2) Assess the prognostic value of the 6MWT in patients with cirrhosis Patients who were assessed for liver transplant (LT) at the University of Alberta hospital were retrospectively enrolled in the study. Cross-sectional imaging within 1 year of assessment was used to determine sarcopenia. The third lumbar vertebra was used to quantify skeletal muscle cross sectional areas, which was then normalized to height to calculate the skeletal muscle index (SMI; cm2/m2). Sarcopenia was defined using pre-established cut-offs in patients with cirrhosis. Cut-offs for 6MWT to predict mortality (death or delisting for being too sick for LT) were determined using receiver-operating characteristic (ROC) curves. Cox proportional hazard models were conducted to assess associations between sarcopenia, functional performance assessed by the 6MWT, and mortality. There were a total of 180 cirrhotic patients who were evaluated for liver transplant who had a 6MWT test at the time of assessment and corresponding CT imaging (Table 1). There was a weak association between SMI and 6MWT observed as dimensional variables (r=0.022; P=0.003). A 6MWT < 489 m was independently associated with mortality, with AUC of 0.61 (95% CI, 0.51–0.71, P=0.03) and subsequently defined as “poor physical performance.” By univariate Cox analysis, both sarcopenia (HR 3.27; 95% CI 1.82–5.89; P<0.001) and low 6MWT (HR 2.72; 95% CI 1.45–5.13; P<0.001) were predictors of mortality. In a multivariate model, adjusted for MELD, sarcopenia (HR 2.96; 95% CI 1.59–5.51; P=0.001) and low 6MWT (HR 2.33; 95% CI 1.21–4.51; P=0.01) were independently associated with mortality. Poor physical performance was observed in 31 (60%) out of 52 sarcopenic patients. Sarcopenic patients with poor physical performance experienced a 6 times higher risk (HR 6.24; 95% CI 2.65–14.68; P<0.001) of death. Sarcopenic patients with low 6MWT survived for 25 months (95%CI, 12–38) compared to 69 months (95%CI, 27–112) in sarcopenic patients with normal 6MWT (Log Rank=0.04). Sarcopenia and poor physical performance independently associate with mortality in patients with cirrhosis. Although poor physical performance was observed in more than half of the sarcopenic patients, its ability to discriminate mortality requires further investigation. None

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