BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutriti...BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutritional management.AIM To assess if rifaximin-α,a minimally absorbed antimicrobial used to manage hepatic encephalopathy(HE),may improve sarcopaenia in cirrhosis through its ammonia lowering and anti-inflammatory properties.METHODS This single-centre retrospective cohort study of patients with prior HE compared patients treated with lactulose alone to those on combination therapy with rifaximin-α.The primary outcome was a change in skeletal muscle area(SMA)as measured by computed tomography over two time points.Secondary outcomes included episodes of spontaneous bacterial peritonitis,variceal bleeding,and gastrointestinal Clostridium difficile infection.RESULTS Of the 142 patients included,63 were on rifaximin-α[35%female,median age 57(51,62)],and 79 were on lactulose without rifaximin-α[20%female,median age 55(51,60)].Univariate analysis for SMA found that male sex(P<0.001),hepatocellular carcinoma presence(P=0.024),and greater baseline body mass index(P=0.001)were associated with improvement of SMA.Multivariate analysis that adjusted for baseline SMA was performed and found only use of rifaximin-α(P=0.029)to be associated with improvement of SMA.CONCLUSION This study demonstrates a significant independent association between rifaximin-αtherapy and muscle mass in patients with cirrhosis and HE.Prospective studies of rifaximin-αtherapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort.展开更多
文摘BACKGROUND Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity.Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutritional management.AIM To assess if rifaximin-α,a minimally absorbed antimicrobial used to manage hepatic encephalopathy(HE),may improve sarcopaenia in cirrhosis through its ammonia lowering and anti-inflammatory properties.METHODS This single-centre retrospective cohort study of patients with prior HE compared patients treated with lactulose alone to those on combination therapy with rifaximin-α.The primary outcome was a change in skeletal muscle area(SMA)as measured by computed tomography over two time points.Secondary outcomes included episodes of spontaneous bacterial peritonitis,variceal bleeding,and gastrointestinal Clostridium difficile infection.RESULTS Of the 142 patients included,63 were on rifaximin-α[35%female,median age 57(51,62)],and 79 were on lactulose without rifaximin-α[20%female,median age 55(51,60)].Univariate analysis for SMA found that male sex(P<0.001),hepatocellular carcinoma presence(P=0.024),and greater baseline body mass index(P=0.001)were associated with improvement of SMA.Multivariate analysis that adjusted for baseline SMA was performed and found only use of rifaximin-α(P=0.029)to be associated with improvement of SMA.CONCLUSION This study demonstrates a significant independent association between rifaximin-αtherapy and muscle mass in patients with cirrhosis and HE.Prospective studies of rifaximin-αtherapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort.
