A prognostic model of acute-on-chronic liver failure based on sarcopenia

肌萎缩 医学 内科学 肝病学 结直肠外科 肝衰竭 外科肿瘤学 胃肠病学 重症监护医学 腹部外科
作者
Hong Peng,Qian Zhang,Lei Luo,Siyi Lei,Tao Xiong,Long Li,Yan Xiong,Liulu Zhang,Jinding Zheng,Xinhua Luo
出处
期刊:Hepatology International [Springer Nature]
卷期号:16 (4): 964-972 被引量:12
标识
DOI:10.1007/s12072-022-10363-2
摘要

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by the development of a syndrome associated with a high risk of short-term death in patients with acute decompensated cirrhosis, and better indicators are needed to predict such outcomes. Sarcopenia, a common complication of cirrhosis, is closely associated with poor prognosis and increased mortality. In this study, the skeletal muscle index of ACLF patients was measured to determine whether sarcopenia combined with clinical parameters can aid in identifying those at high risk of progression. Methods A total of 433 hospitalized patients with ACLF according to the APASL criteria were included and allocated into two groups: transplantation-free survival ( n = 293) or progression ( n = 140, 107 died; 33 underwent liver transplantation) within 90 days. Muscle mass was assessed based on the skeletal muscle index. The optimal cut-off value of the AMPAS1 model (age, MELD score, platelet count, alpha-fetoprotein level, sarcopenia, and more than one complication combination) for progression prediction was identified using receiver-operating characteristic (ROC) analysis. Results Sarcopenia was an independent risk factor for progression in the ACLF population (HR 3.771 95% CI 2.114–6.727, p < 0.001). AMPAS1 was a good predictor, with an area under the ROC curve of 0.865, and the cut-off value for poor outcome prediction was 0.31 (sensitivity 79.4%, specificity 76.4%). Conclusion We demonstrate that sarcopenia is a simple and objective indicator for predicting short-term prognosis in patients with ACLF. Moreover, compared to conventional prognostic scores, AMPAS1 is a better model for predicting 90 day adverse outcomes in ACLF patients.
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