Introduction

Sarcopenia is an underdiagnosed complication occurring during cirrhosis. Assessing its influence on the morbi-mortality is not enough studied in cirrhotic patients especially in countries where hepatic transplantation is rarely available.

Aims & Methods

Aims: Evaluate the prevalence and prognostic impact of radiological sarcopenia in cirrhotic patients
Methods: Longitudinal retrospective study including cirrhotic patients who had an abdominal computed tomography (CT) scan over 6 years. Sarcopenia was defined ,on a sagittal CT slice at the umbilicus, by a psoas muscle thickness related to height (TPMT/h) of less than 16.8 mm/m. Two groups were defined (G1: presence of sarcopenia/G2: absence of sarcopenia) and compared regarding their survival and the occurrence of subsequent complications.

Results

70 patients were included with a mean age of 62 year and a sex ratio of 0.8. Their average mean BMI was 27.67 kg/m². Viral etiology of cirrhosis was predominant (49%) with a mean MELD score of 12.81. The mean TPMT/h was 13.56 mm/m. Radiological sarcopenia was noted in 44 patients (63%). At the time of inclusion, the baseline characteristics of the 2 groups were comparable except for the predominance of women (p=0.006) and refractory ascites (p=0.032) in G1. At the end of an average 21-month follow-up, sarcopenia was associated with a higher number of complications per patient (p=0.013) and a longer average duration of hospitalization per patient (p=0.001). Overall survival was decreased in G1 with a statically significant difference (p=0.035). Survival rates at 6 months, 1 year and 2 years were respectively 42%, 30% and 24% in G1 versus 67%, 40%, 27% for G2. The survival study concluded that sarcopenia is an independent factor of mortality (OR=2,5 ;95% IC [1,02-6,16] ; p=0,045) in our patients.

Conclusion

Sarcopenia is frequent in patients with cirrhosis. It is an independent poor prognostic factor that needs to be recognized in this population. The TPMT/h offers an easy and often available method for the diagnosis of this complication.

Introduction

Cirrhosis is characterized by structural and functional hepatic alterations. The associated metabolic imbalances and psycho-neurological factors contribute to the high prevalence of sexual disorders and erectile dysfunction among affected patients. The aim of our study was to identify factors associated with sexual dysfunction in cirrhotic patients.

Aims & Methods

We conducted a prospective cross-sectional study, collecting data from patients followed for cirrhosis at the gastroenterology department of Charles Nicolle Hospital in Tunis over a one-year period. Female sexual function was assessed using the FSFI questionnaire. Female sexual dysfunction was defined by an FSFI score below 26 (or below 20 in post menopausal women). Male sexual function was evaluated using the IIEF-15 questionnaire. Male sexual dysfunction was identified by an IIEF-15 score below 42.9. Erectile dysfunction was confirmed by an IIEF-5 score
below 26. An analytical statistical study was conducted, highlighting factors associated with sexual dysfunction in both female and male patient groups.

Results

We included 55 cirrhotic patients (24 women and 31 men), with a sex ratio (M/F) of 1.29 and a mean age at inclusion of 59.11 ± 12.16 years. Female sexual dysfunction was observed in 70.8% of female patients. Male sexual dysfunction was found in 61.3% of patients. Erectile dysfunction was reported in 74.1% of men. Our study showed that the factors associated with female sexual dysfunction were: low economic status (p = 0.007), the presence of arterial hypertension (p = 0.026), and hepatic disease severity attested by Child-Pugh class B/C and MELD score >15 (p = 0.049 and p = 0.018, respectively). In male patients, a higher prevalence of sexual dysfunction was found among smokers patients (p = 0.045; OR = 0.18; 95% CI [0.03; 1.05]) and them who consumed alcohol (p = 0.042; OR = 0.19; 95% CI [0.04; 0.94]). In multivariate analysis, only alcohol consumption was independently associated with male sexual dysfunction (p = 0.041; OR = 9.187). MELD score >15

Conclusion

In conclusion, our study highlights the high frequency of sexual disorders in cirrhotic patients and identifies several associated factors, notably the severity of liver disease, socioeconomic
status, and certain comorbidities. For these reasons, screening and appropriate management of sexual dysfunction is essential in cirrhotic patients especialy with advanced disease or comorbidities.

Introduction

Frailty is a complex clinical syndrome characterized by a reduction in physiological reserves and an increased vulnerability to stressors. Although it is often associated with aging, frailty also affects younger populations, particularly patients with severe chronic illnesses such as cirrhosis.
The objective of our study was to assess the prevalence of frailty among cirrhotic patients in a Tunisian population and to identify associated risk factors.

Aims & Methods

An analytical cross-sectional study was conducted over a three-month period in the gastroenterology department of Sahloul University Hospital in Sousse. Patients aged 18 to 70 years, diagnosed with cirrhosis (based on clinical, biological, morphological, endoscopic, and/or histological criteria) were included. Patients with severe chronic diseases that could overestimate frailty or with osteoarticular diseases limiting mobility were excluded.
Frailty was assessed using the Clinical Frailty Scale (CFS) for global frailty (GF) and the Short Physical Performance Battery (SPPB) for physical frailty (PF).

Results

A total of 50 patients were included. The median age was 59 ± 9.2 years, with a male-to-female ratio of 1.5. The main etiologies of cirrhosis were metabolic liver disease (38%) and hepatitis B-related cirrhosis (28%). According to the Child-Pugh score, 39% of patients were classified as Child A, 36% as Child B, and 26% as Child C, with an average MELD score of 14.2 ± 5.9.
Regarding frailty, 42% of patients exhibited GF and 46% had PF.
Univariate analysis revealed several factors significantly associated with GF, namely: female gender (p=0.035), age >60 years (p=0.02), presence of grade I hepatic encephalopathy (p=0.038), presence of ascites (p<0.001), BMI < 18.5 kg/m² (p=0.037), sedentary lifestyle (p<0.001), MELD score >15 (p=0.001), and Child-Pugh score B-C (p=0.003).
For PF, similar results were observed: age >60 years (p=0.03), presence of ascites (p<0.001), sedentary lifestyle (p=0.009), and MELD score >15 (p=0.001).
Multivariate analysis identified independent risk factors associated with both GF and PF as: age >60 years, presence of ascites, and a MELD score >15.

Conclusion

This study highlights the high prevalence of frailty among cirrhotic patients, emphasizing the importance of systematic assessment of this condition in clinical practice. Age, ascites, and the severity of cirrhosis were found to be significant indicators of frailty. These findings suggest the need to implement targeted rehabilitation programs to improve physical function and quality of life in this patient population.

Introduction

Sarcopenia, defined as the loss of skeletal muscle mass, quality, and function, is an important metabolic disorder associated with malignancies and is an independent predictive factor for mortality in malignant patients [1]. Hepatocellular carcinoma (HCC) is the most common type of malignant liver cancer, and sarcopenia has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC [1]. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications.

Aims & Methods

In this study, the material and methods involved the inclusion of 101 patients who were diagnosed with HCC and had admission CT images in the system between February 2019 and October 2021. The study evaluated the effect of admission Visceral-Subcutaneous Fat Ratio (VSR) indicating visceral adiposity and Intramuscular Adipose Tissue Content Ratio (IMAC) on mortality in patients with HCC . The VSR and IMAC were calculated for each patient using CT image analysis. The study did not involve any interventions or treatments, and all data were collected retrospectively. The study was approved by the institutional review board, and all patients provided informed consent for the use of their medical records for research purposes.
We aim to evaluate the effect of admission VSR indicating visceral adiposity and IMAC on mortality in patients with HCC.

Results

The median age of the patients was 61.4 (21-77) years, and 77 (76.2%) of the patients were male. Sixty-two of the patients (62%) had Child Pugh Score (CPS) A, and the 12-month transplant-free survival rate was 78.2%. The study found that there was a positive correlation between age and diagnosis time IMAC (R= 0.337, p=0.045) and a weak positive correlation with VSR (R= 0.223 and p= 0.045). Fourteen patients were excluded from the mortality analysis because they had undergone transplantation during this period. The study found that the percentage of patients with HCC in Milan criteria was 44.9% (n:44).In an analysis of 87 patients, IMAC and VSR were associated with mortality independently of CPS (p=0.017 and p=0.048, respectively).

Conclusion

In conclusion, sarcopenia is an important indicator in predicting mortality and morbidity in patients with HCC independent of CPS. Nevertheless, the concurrent evaluation of radiological and clinical sarcopenia must be evaluated to determine the relationship between sarcopenia and mortality in HCC patients. The large population studies provide more accurate results.

Disclosure

No conflict of interest

Introduction

This study aimed to evaluate the prognostic value of choline positron emission tomography/computed tomography (PET/CT) compared with MRI and fluorodeoxyglucose (FDG) PET/CT in treatment-naïve hepatocellular carcinoma (HCC) patients, emphasizing clinical relevance to overall survival (OS).

Aims & Methods

Seventy-eight patients with treatment-naïve HCC (median age: 67 years, 87% male, 87% cirrhotic) underwent baseline MRI, choline and FDG PET/CT imaging at Erasme Hospital between 2018 and 2022 (Protocol ID: P2023/279). Tumor volumes delineated on MRI were registered onto PET/CT scans and were assessed using median values as thresholds. Imaging parameters (tumor volumes, SUVmax, and SUVmean) were assessed for their prognostic significance. Linear correlation between MRI and choline volumes was evaluated and multivariate models were created using median tumor volume thresholds. Comparative Kaplan-Meier survival analysis and multivariate Cox regression, adjusting for treatment modality (transplantation, hepatectomy, locoregional therapies), were conducted and Holm Bonferroni correction was applied. Associations between imaging parameters and clinical biomarkers (AFP and ALBI score) were explored.

Results

High correlations (Choline r=0.94, FDG r=0.97) between SUVmax and SUVmean in both tracers imply redundancy, favoring volume-based parameters integrating metabolic and anatomical data. Higher tumor volumes measured by MRI (>17.81 mL; HR 3.15, p=0.005), choline PET/CT volumes (>8.4 mL; HR 2.27, p=0.04), and FDG PET/CT positivity (HR 2.74, p=0.02) significantly predicted poorer OS in univariate analysis. After multivariate adjustment and Holm-Bonferroni correction, only MRI-derived tumor volume remained an independent predictor (p=0.015). Notably, FDG uptake ≥1% of MRI-defined tumor volume correlated significantly with poorer OS (p=0.03). Liver transplantation and hepatectomy significantly improved survival compared to locoregional therapies (p=0.006). In the liver transplantation group, FDG and choline volumes do not significantly affect OS (p = 0.08, and 0.4 respectively). Imaging parameters did not correlate significantly with AFP or ALBI scores.

Conclusion

Choline PET/CT provided no additional prognostic value compared with MRI or FDG PET/CT in patients with treatment-naïve HCC.

Disclosure

i do not have any conflictof interest

Introduction

Sarcopenia, a progressive loss of skeletal muscle mass and function, is a significant predictor of adverse outcomes in liver transplant patients, including infections. This study evaluates the relationship between pre-transplant sarcopenia and infection rates at one, three-, and six-months post-transplantation, using radiological markers such as skeletal muscle mass index (SMII), intramuscular adipose tissue content (IMAC), and visceral/subcutaneous fat area ratio (VSR).

Aims & Methods

This retrospective study analysed 102 liver transplant recipients undergone surgery between July 2012 and July 2023. Computed tomography (CT) scans taken within 30 days prior to transplantation were evaluated to assess sarcopenia using SMII, IMAC, and VSR. Demographics, clinical parameters, and infection rates at one, three, and six months were compared. Pre-transplant sarcopenia indicators were assessed for their correlation with early and late infection rates. Using a forward conditional method for variable selection, logistic regression was applied to identify significant predictors of infection up to the third month post-transplant. Statistical analyses included chi-square and Mann-Whitney U tests.

Results

The median age of the cohort was 51 years, and 31.4% were female. Patients were categorized into sarcopenic (n=41) and non-sarcopenic (n=61) groups based on preoperative imaging data. Sarcopenia was significantly less prevalent in females (17.1% vs. 41%; p=0.016). Sarcopenic patients had a lower median SMII (61.54 vs. 100; p<0.001) and higher preoperative MELD-Na scores (24 vs. 18; p=0.02). One-month infection rates were significantly higher in sarcopenic patients (48.8% vs. 27.8%; p=0.032), as were three-month rates (65.8% vs. 44.2%; p=0.043). By six months, infection rates were similar between groups (60.7% vs. 57.3%; p=0.41). Logistic regression identified sarcopenia (OR = 10.92, 95% CI [1.53, 78.09], p = .017), urea (OR = 1.10, 95% CI [1.03, 1.17], p = .003), INR (OR = 6.03, 95% CI [1.05, 34.52], p = .044), and age (OR = 0.91, 95% CI [0.84, 0.99], p = .035) as significant predictors of infection up to the third month. While diabetes mellitus (DM) was not statistically significant (p > .05), its inclusion enhanced the model's predictive power. These findings indicate that higher sarcopenia, urea, and INR values increase infection risk, while older age appears protective.

Conclusion

Pre-transplant sarcopenia is strongly associated with increased infection rates in the first three months following liver transplantation. However, by six months, the comparable infection rates suggest that sarcopenia-related risks may diminish with recovery. These findings underscore the importance of addressing sarcopenia preoperatively through tailored interventions.