Letter: the diagnostic value of ultrasound‐based versus CT ‐based sarcopenia measurement in cirrhosis

This article is linked to Artru et al papers. To view these articles, visit https://doi.org/10.1111/apt.16080 and https://doi.org/10.1111/apt.17398 We read with great interest the study by Artru and colleagues identifying the improvement of sarcopenia after implantation of transjugular intrahepatic portosystemic shunt (TIPS) in a CT-based analysis of body composition.1 We fully agree on sarcopenia being an important prognostic factor in patients with decompensated cirrhosis not only for mortality but also for development of cirrhosis-associated complications.2, 3 Currently, as proposed by the EASL Clinical Practice Guidelines the main tool to assess sarcopenia in cirrhotic patients is cross-sectional CT imaging, in which paravertebral and abdominal wall muscle mass could be quantified to define skeletal muscle index.4 However, repeated CT scans involve radiation exposure, higher costs and thus cannot be used as point-of-care diagnostic. Hence, the question is whether ultrasound measurements are an alternative technique to evaluate sarcopenia in clinical practice. In CT scans, we analysed the transversal psoas muscle thickness (TPMT) as described previously,5 comparing it with ultrasound measurement of thigh muscle thickness (standardised to patient height) performed within 6 weeks. Ultrasound measurements were performed by DEGUM (German Association for Ultrasound in Medicine) certified hepatologists. The mean value of three measurements was used for the analysis. We included 127 patients with decompensated cirrhosis. Two-thirds of the included patients were male. There was no significant difference in age, but weight and height were significantly higher in male patients. In all 127 included patients reliable and successful ultrasound measurements could be taken, CT scan was available in 94 patients. Also, there was no significant difference in MELD (mean 12.1 ± 5.4) or Child Pugh Score (mean 6.9 ± 1.4) between both sexes. Measurements of the muscle thickness in US and CT correlate significantly in the study group (R 0.526, p < 0.01) and for both sexes (male R 0.551, p < 0.01; female R 0.578, p < 0.05) (Figure 1). However, correlation coefficient was only moderate at best. Our data indicate that ultrasound measurements may be used as an alternative to CT scans for evaluation of skeletal muscle as it is widely available, easy to use and a fast and cost-effective method. However, moderate correlation makes validation for clinical endpoints necessary. Moreover, the value of longitudinal muscle measurements for repeated assessment of the patients' nutritional status remains to be studied in the context of decompensated cirrhosis. In conclusion, our data suggest that ultrasonic muscle measurement could be a promising clinical tool. However, further studies on clinical outcome and the prognostic value of longitudinal measurements are needed to verify that ultrasound is as an effective tool for sarcopenia surveillance. Juliana Gödiker: Data curation (equal); formal analysis (lead); methodology (equal); project administration (equal); resources (supporting); validation (equal); visualization (lead); writing – original draft (lead); writing – review and editing (equal). Kim Krüger: Conceptualization (equal); data curation (lead); formal analysis (equal); methodology (equal); writing – original draft (lead); writing – review and editing (supporting). Lea Schwind: Data curation (equal); formal analysis (equal); methodology (equal); validation (equal); writing – review and editing (supporting). Torid Jacob: Data curation (supporting); formal analysis (equal); methodology (supporting); writing – review and editing (supporting). Johannes Chang: Formal analysis (supporting); methodology (supporting); project administration (supporting); resources (equal); writing – review and editing (supporting). Michael Köhler: Investigation (supporting); methodology (supporting); writing – review and editing (equal). Jonel Trebicka: Project administration (equal); resources (equal); supervision (equal); writing – review and editing (equal). Michael Praktiknjo: Conceptualization (lead); data curation (equal); formal analysis (equal); funding acquisition (lead); investigation (equal); methodology (lead); project administration (lead); resources (lead); supervision (lead); validation (lead); writing – original draft (equal); writing – review and editing (lead). Declaration of personal interests: All authors declare no conflict of interest. Declaration of funding interests: Johannes Chang is funded by grants from the Else Kröner-Fresenius-Stiftung (2014_Kolleg.05) and BONFOR research program of the University of Bonn (grant ID 2019-2-08). Jonel Trebicka is supported by the German Research Foundation (DFG) project ID 403224013 – SFB 1382 (A09), by the German Federal Ministry of Education and Research (BMBF) for the DEEP-HCC project and by the Hessian Ministry of Higher Education, Research and the Arts (HMWK) for the ENABLE and ACLF-I cluster projects. The MICROB-PREDICT (project ID 825694), DECISION (project ID 847949), GALAXY (project ID 668031), LIVERHOPE (project ID 731875), and IHMCSA (project ID 964590) projects have received funding from the European Union’s Horizon 2020 research and innovation program. Michael Praktiknjo is funded by the Ernst-und-Berta Grimmke Foundation (No. 5/19) and BONFOR research program of the University of Bonn (grant ID 2020-2A-07 and 2021-2A-07) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy – EXC2151 – 390873048.