Frequency and Clinical Impact of Sarcopenia in Cirrhotic Patients with and without Hepatocellular Carcinoma
Notice bibliographique
Résumé
Purpose: Prognostic assessment of patients (pts) with cirrhosis remains a challenge, as the natural history is highly variable due to several factors, including hepatic synthetic function, and development of hepatocellular carcinoma (HCC) among others. Sarcopenia is defined as low levels of muscle mass, and this syndrome may be present in chronic and malignant diseases; however, it is not well studied and understood in pts with cirrhosis and pts with HCC. We aimed to establish the frequency of sarcopenia and if it predicts mortality in a cohort of cirrhotic pts with and without HCC. Methods: 163 pts with cirrhosis that were consecutively evaluated for liver transplant and had a computed tomography (CT) scan at the 3rd lumbar vertebrae were selected. Data were recovered from medical charts, skeletal muscle cross-sectional area was measured by CT in order to determine the L3 skeletal muscle index (L3 SMI) defined as total lumbar muscle cross sectional area adjusted for stature, and sarcopenia was defined using previously published gender-specific cutoffs. Results: 118 pts were males (72%), the mean age was 55±1 years, and 51 pts (31%) had HCC at the time of the CT. Median time of follow-up was 19±1 months. Etiology of liver cirrhosis was HCV (34%), alcohol (20%), autoimmune liver disease (13%), HBV (6%), and others (27%). Sarcopenia was present in 61 pts (37%), and there was no difference in the frequency of sarcopenia among pts with and without HCC (31% vs. 40%, P=0.3). By univariate Cox analysis the bilirubin (HR 1.01; P<0.001), INR (HR 6.42; P<0.001), creatinine (HR 1.01, P=0.001), albumin (HR 0.95, P=0.006), MELD (HR 1.12; P<0.001), Child-Pugh (HR 2.09; P<0.001), sodium (HR 0.89; P<0.001), L3 SMI (HR 0.98, P=0.05), and sarcopenia (HR 2.19; P=0.001) were associated with mortality. The presence of HCC was not associated with increased mortality (HR 1.12; P=0.6). By multivariate Cox regression analysis only the MELD score (HR 1.08, P=0.001), and sarcopenia (HR 2.18, P=0.001) were independently associated with early mortality. Median survival for sarcopenic pts was 19±5 months, compared to 30±2 months in non-sarcopenic pts (P=0.001). There was a poor correlation between sarcopenia and MELD score (r -0.13, P=0.1) and sarcopenia and Child-Pugh score (r 0.04, P=0.6). Conclusion: Sarcopenia is present in more than one third of pts with cirrhosis, and is not associated with the presence of HCC. Sarcopenia constitutes a strong and independent predictor of mortality in pts with cirrhosis and does not correlate with degree of liver dysfunction evaluated with conventional scoring systems. Further studies that include sarcopenia with conventional scores may allow significantly better prediction of mortality among cirrhotic pts with and without HCC.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».