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

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.

Introduction

The prognosis for patients with hepatocellular carcinoma (HCC) remains extremely poor, with a 5-year survival rate of 20% without curative treatment. A recent studyⁱ demonstrated that the use of a computed CT score including muscle density and muscle area could identify frailty in cirrhotic patients and predict 6-month mortality. The objective of the study was to evaluate predictors of 6-month mortality in patients with HCC and to establish the impact of sarcopenia in this context.

Aims & Methods

We performed a retrospective analysis of 86 patients with HCC treated at the Hôtel Dieu de France in Beirut between 2016 and 2024. The collection included clinical and biological data, prognostic indices (Child Pugh scores, MELD) as well as CT parameters for measuring sarcopenia and myosteatosis, including skeletal muscle index, muscle densities, and muscle surfaces at L3 level. The coreslicer® software was used to calculate muscle and fat surfaces on CT. The measurements evaluated included the surfaces at L3 of the psoas and paravertebral and parietal muscles, as well as the density of the psoas. Among these, the “L3 skeletal muscle area adjusted to height and density ratio (L3- SMHDR)” which is calculated by the total muscle area at the L3 level * Average size / density of the psoas muscles at the L3 level. This measurement helps include myosteatosis in the assessment of sarcopenia.

Results

• Our population included 86 patients with HCC, 74 men, 12 women, with a mean age of 66.1 ± 10.7 years. MELD-Na score was 16.1 ± 8.2, and Child-Pugh score was A, B, and C in 39%, 27%, and 34%, respectively. Twelve patients (14%) were eligible for curative treatment, in accordance with BCLC guidelines.
• Decreased survival is significantly associated with increasing L3-SMHDR. An AUROC analysis for L3-SMHDR as a predictor of mortality at 1 month found the same cutoff values as a previously published study with cutoffs of 5.4 and 4.7 in men and women, respectively. Populations with low L3-SMHDR vs. high L3-SMHDR had a survival time of 31.2 months vs. 11.09 months (P=0.035).
• In order to determine the different factors linked to a decrease in survival at 6 months, we conducted a univariate analysis which identified the following parameters: muscle density at scan (p=0.016), L3-SMHDR (p=0.004), L3-DRMI (p=0.034) and the MELD-Na score (P=0.077). A value of L3-SMHDR > threshold had a risk of mortality OR= 7.8 [1.8-34, P=0.003] and 5.64 [1.3-23.8, P=0.013] at 6 and 12 months respectively.
• In multivariate analysis, the two independent prognostic factors were the MELD-Na score and L3-SMHDR, which allowed us to arrive at the following equation:
• Probability = 0.112* MELDNa + 2.518* L3-SMHDR – 3.11.
• This analysis allowed us to classify patients according to the above function categories, and to estimate the risk of mortality at 6 and 12 months at respectively OR = 10 [2-50, P=0.003] and 11.4 [2.2-58.6, P=0.002].

Conclusion

The 6-month prognosis of patients with HCC depends primarily on liver function and the severity of sarcopenia and myosteatosis, not tumor stage. This should provide additional prioritization for patients eligible for liver transplantation. Confirmation of these results should be considered in a larger-scale study.

References

i. El Khoueiry C, Slim R, Rida M, Khoury B, Honein K, Smayra T, Yaghi C. New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact. Middle East J Dig Dis. 2024 Apr;16(2):102-108. doi: 10.34172/mejdd.2024.376. Epub 2024 Apr 30. PMID: 39131107; PMCID: PMC11316193.

Introduction

Sarcopenia is increasingly recognized as a major prognostic factor in patients with hepatocellular carcinoma (HCC). Its evaluation may improve patient risk stratification and therapeutic decision-making

Aims & Methods

To assess the prevalence of sarcopenia among patients with hepatocellular carcinoma (HCC), identify associated factors, and evaluate the MELD-sarcopenia score as a potential predictor of mortality.
We conducted a retrospective monocentric study over a 10-year period, including patients aged over 18 years with a confirmed diagnosis of HCC based on radiological, biological, and/or histological criteria. Only patients with an available abdominal CT scan including the L3 vertebral level were included. Exclusion criteria were liver transplantation, other primary liver tumors, non-HCC malignancies, incomplete records, or poor-quality imaging. Sarcopenia was diagnosed by calculating the Total Psoas Area Index (TPAI) on CT, using thresholds of 5.45 cm²/m² for men and 3.85 cm²/m² for women. MELD and MELD-sarcopenia scores were calculated. Survival time from HCC diagnosis was recorded.

Results

Among 30 screened patients, 5 were excluded due to missing imaging. In the final cohort of 25 patients, the prevalence of sarcopenia was 52%. Compared to non-sarcopenic patients, sarcopenic patients were older (67.6 vs 56 years) and more often male. The most frequent etiology in sarcopenic patients was hepatitis C (46.2%), while hepatitis B was predominant in non-sarcopenic patients (58.3%). Cirrhosis was mostly compensated in both groups. HCC was typically unifocal, infiltrative, and multilobar in both groups. The mean time from HCC diagnosis to death was shorter in sarcopenic patients (13.4 vs 33.9 months). Male sex and older age were significantly associated with sarcopenia (p < 0.05), whereas tumor characteristics, Child-Pugh class, and biological tests were not. Kaplan-Meier analysis showed a tendency toward worse survival in patients with higher MELD-sarcopenia scores, although the difference was not statistically significant (p > 0.05).

Table : Comparison of clinical and survival characteristics between sarcopenic and non-sarcopenic patients with hepatocellular carcinoma

Conclusion

Sarcopenia is highly prevalent among patients with HCC and is independently associated with male sex and older age. The MELD-sarcopenia score appears to be a promising tool for mortality risk stratification and may aid clinical decision-making.

References

https://pubmed.ncbi.nlm.nih.gov/21893129/

Disclosure

There were no conflicts of interest.

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

Toxic hepatitis is a significant hepatic condition that can occur due to drugs, fungi, herbal agents and supplements, sometimes progressing fulminantly and resulting in transplantation or mortality. As it is a diagnosis of exclusion, it can be challenging to establish and the etiological factors vary societally. In our study, we investigated the etiology, epidemiology, factors related to prognosis, and clinical outcomes of patients diagnosed and treated for toxic hepatitis.

Aims & Methods

The demographic characteristics, etiological factors, laboratory and imaging results, biopsy findings, and information about the drugs used in the treatment of 254 patients hospitalized and treated for toxic hepatitis between February 2019 and June 2022 at Ankara Bilkent City Hospital were retrospectively examined. After evaluating the results according to the RUCAM scale, patients interpreted as possible and highly probable were included in the study, and they were classified based on severity as mild, moderate, severe or fatal.

Results

Of the patients included in the study, 60.6% were female, and 30.3% of these patients presented to the hospital with jaundice symptoms. The mean age of the patients was 43.9 years. Hepatocellular damage was observed in 68.5% of the developed liver toxicities. The most common etiological factors were antibiotics and NSAIDs in sequence. When antibiotic drugs were evaluated separately, amoxicillin-clavulanate (9.8%) was considered the most common antibiotic causing toxic hepatitis, and dexketoprofen (9.1%) was identified as the most common NSAID. A total of 45 patients (18.1%) were associated with herbal and dietary supplements, while 18 patients (7.1%) were related to mushroom consumption in the etiology. Of the patients included in the study, 56% had a moderate or severe hepatitis course, 3 (1.18%) patients progressed to liver transplantation, and 6 (2.5%) patients died, including one post-transplant. The severity of toxic hepatitis was mild in 109 participants (42.9%), moderate in 89 patients (35.0%), severe in 48 patients (18.9%), and fatal in 8 patients (3.1%). In 5.9%, there was worsening of the disease (transition from mild
or moderate severity to severe or fatal groups) after admission. In our study, 14.3% of patients in the severe-fatal group died due to acute liver failure or underwent liver transplantation. Both groups exhibited a dominant pattern of hepatocellular-type damage, and there was no difference in the evaluation of etiological factors between the groups. When biochemical parameters were evaluated, elevation in ALT, AST, LDH, initial and peak total bilirubin, direct bilirubin, initial and peak INR, prolonged prothrombin time, and low albumin were significant in both the severe patient group and the group admitted to intensive care. Liver biopsy was performed on 60 of the 254 patients included in the study.

Conclusion

In our study, the median age, gender distribution, dominant injury type, and the most commonly detected agents in etiology (NSAIDs and antibiotics) and dominant were consistent with the literature. Factors such as the consumption of Toxic hepatitis is a disease that can be challenging to diagnose and treat. Given that our center receives a high number of patient admissions, accepts patients from surrounding areas, and serves as a transplant center, we believe that the data we have obtained can closely approximate current and real data. We also believe that our study on these 254 patients will contribute to the literature in terms of etiological, epidemiological, and prognostic insights.