Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This s...Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.展开更多
基金the approval of Ethics Committees of Union Hospital Tongji Medical College,Huazhong University of Science and Technology(No.2022-S207)The First Affiliated Hospital of Soochow University(No.2022412)The First Hospital of Shanxi Medical University(No.2022KK094).
文摘Aims:Although the skeletal muscle index at the third lumbar vertebra(L3-SMI)is commonly utilized for the diagnosis of sarcopenia,the psoas muscle index at L3(L3-PMI)may serve as a reliable alternative indicator.This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt(TIPS).Methods:This study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China.Clinical and imaging data,specifically L3-SMI and L3-PMI,were collected for these patients.The prognosis of the patients was assessed through re-examinations and telephone follow-ups,which extended up to 5 years.The diagnostic thresholds for sarcopenia,as defined by L3-PMI and L3-SMI,were established at 6.36 or 42.00 cm^(2)/m^(2) for males and 3.92 or 38.00 cm^(2)/m^(2) for females,respectively.Cox proportional hazards and Kaplan–Meier(K-M)analyses were employed to evaluate patient survival.Results:The findings indicated that both L3-PMI and L3-SMI before TIPS were independent risk factors for mortality.The results of the paired t-test demonstrated a significant increase in L3-PMI 1 month post-TIPS(5.11±1.81 vs.5.71±1.90 cm^(2)/m^(2) ,p<0.001),whereas L3-SMI did not exhibit a significant increase until 6 months post-TIPS(45.45±9.41 vs.48.59±10.38 cm^(2)/m^(2) ,p<0.001).Among these patients,191(47.0%)and 159(39.2%)were diagnosed with sarcopenia according to the L3-PMI and L3-SMI models,respectively.Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate(L3-SMI model:hazard ratio[HR],1.913;95%confidence interval[CI],1.094–3.410;log-rank p=0.020;L3-PMI model:HR,1.867;95%CI,1.059–3.290;log-rank p=0.030).In sarcopenic patients,the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3-PMI model(HR,2.675;95%CI,1.245–5.735;log-rank p=0.012),while a similar effect was not observed until 6 months post-TIPS in the L3-SMI model(HR,3.342;95%CI,1.477–7.560;logrank p=0.004).Conclusions:L3-PMI and L3-SMI demonstrate comparable efficacy in diagnosing cirrhosis-related sarcopenia.Furthermore,L3-PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS,thereby providing earlier insights into patient survival outcomes.
