Impact of Gender-Dependent Body Composition Disparity Evaluated by Computed Tomography on Mortality Risk in Cirrhotic Patients
Bibliographic record
Abstract
Introduction: Prognostic significance of adipose tissue in cirrhotic patients is not clear. We determined the impact of two major body compartments, muscle and adipose tissue, on mortality in 677 cirrhotic patients evaluated for liver transplant (LT). Methods: CT images taken at the 3rd lumbar vertebra were applied to determine 3 body composition variables, each normalized to height to calculate indices (cm2/m2): visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and skeletal muscle index (SMI). Cox proportional hazard models were conducted to assess associations between mortality and body composition. Results: The majority of patients were male (67%) with a mean age of 57±8 years, MELD score of 14±7 and BMI of 27±6 kg/m2. Patients were followed (21.4 ± 30.2 months) until death (n=258), LT (n=248) or last visit (n=171). Despite similar BMI between genders, men had greater SMI (53±12 vs. 45±9) and VATI (39 ±30 vs. 31±22) whereas SATI (67±52 vs. 48±37) was higher in females [p < 0.001 for each]. Patients who died had lower SMI (49±12 vs. 51±11), and SATI (47±41 vs. 59±44) [p < 0.001 for each], but similar BMI and VATI. By univariate Cox analysis, SATI (HR 0.99; 95% CI 0.99-1.00; p=0.001), MELD (HR 1.05; 95% CI 1.03-1.07; p< 0.001), age (HR 0.98; 95% CI 0.97-1.00; p=0.05), and SMI (HR 0.98; 95% CI 0.96-0.99; p< 0.001) were predictors of mortality. SATI independently associated with mortality (HR 0.99; 95% CI 0.99-1.00; p=0.03), after adjusting for MELD score, SMI and age. In a subanalysis by gender, SATI was lower (52±43 vs. 77±55; p< 0.001) in female patients who died whereas SMI (51±12 vs. 54±12; p=0.04) was lower in deceased male patients. In gender stratified multivariate analyses, MELD (HR 1.07; 95% CI 1.03-1.10; p < 0.001) and SATI (HR 0.99; 95% CI 0.98-1.00; p=0.005) were independent predictors of mortality in females whereas in males, MELD (HR 1.04; 95% CI 1.02-1.07; p < 0.001) and SMI (HR 0.97; 95% CI 0.95-0.99; p=0.002) were significant predictors.Figure: Female patients with the same BMI, A) with low SATI and B) normal SATI.Figure: Male patients with the same BMI, A) with low SMI and B) with normal SMI.Conclusion: A lower amount of subcutaneous adipose tissue associates with higher mortality in female patients. On the other hand, depletion of skeletal muscle predicts mortality in male patients. This emphasizes the necessity for studies to investigate potential interactions between muscle mass and subcutaneous adiposity on mortality in patients with cirrhosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".