Myosteatosis for Early Detection of Muscle Disorder in Patients With Liver Cirrhosis

Shubhankar Godbole; Syeda Juveria; Nitin Jagtap; Anand Kulkarni; Prasanthi Lanka; Sameer Sheikh; Padaki N Rao; Madhulika Arulta; Sowmya Tr; Sonam Shah; Duvvur N Reddy; Mithun Sharma

doi:10.1016/j.jceh.2023.101312

Myosteatosis for Early Detection of Muscle Disorder in Patients With Liver Cirrhosis

J Clin Exp Hepatol. 2024 Mar-Apr;14(2):101312. doi: 10.1016/j.jceh.2023.101312. Epub 2023 Dec 4.

Authors

Affiliations

¹ Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
² Department of Hepatology, Division of Liver Nutrition, Asian Institute of Gastroenterology Hospitals, Hyderabad, India.
³ Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India.
⁴ Department of Hepatology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India.
⁵ Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology Hospitals, Hyderabad, India.
⁶ Department of Nutrition, Asian Institute of Gastroenterology, Hyderabad, India.
⁷ Department of Radiology, Asian Institute of Gastroenterology, Hyderabad, India.
⁸ Hepatology and Regenerative Medicine, Asian Institute of Gastroenterology and AIG Hospitals, Hyderabad, India.

PMID: 38274507
PMCID: PMC10805908 (available on 2025-03-01)
DOI: 10.1016/j.jceh.2023.101312

Abstract

Background and aims: Muscle disorders in cirrhosis are associated with poor outcome and need early identification. Anthropometric measures lack sensitivity, and CT-based L3-skeletal muscle Index (L3-SMI) may miss early sarcopenia. The study aimed to find if SM-RA can identify more patients with muscle disorder than L3-SMI and anthropometry.

Methods: 388 patients with cirrhosis underwent nutritional assessment by anthropometry, short-physical-performance-battery (SPPB) < 9, L3-SMI (<36.5 cm²/m² (males); <30.2 cm²/m² (females), and myosteatosis assessment by skeletal muscle radiation attenuation (SM-RA) (<41 HU for body mass index [BMI] <24.9 kg/m² and <33 HU for ≥25 kg/m²) and results were compared.

Results: Sarcopenia based on SPPB was 38.9 % with scores (9 ± 1.48 vs. 10.74 ± 1.25, P = 0.001 in males; and 8.43 ± 1.59 vs. 9.89 ± 1.57, P = 0.001 in females). Mid-arm muscle circumference was lower in sarcopenic males [20.5 ± 2.42 vs. 22.9 ± 2.19 cm, P = 0.001] but not in females [19.4 ± 2.73 vs. 21.1 ± 2.51, P = 0.18]. L3-SMI-based sarcopenia was found in 44.8 % (additional 5.92 %) compared to SPPB, mostly in cryptogenic cirrhosis (19.2 % vs. 35.08 %, δ change +15.9 %). Myosteatosis (71.64 %) identified an additional 26.85 % and 32.74 % of patients with muscle disorder compared to L3SMI and SPPB, respectively, with the majority of new detection in non-alcoholic fatty liver disease (NAFLD) 39.4 % vs. 77.06 %, δ change +37.66 %) CTP-A patients (16.6 % vs. 36.8 %, δ change +20.2 %). Myosteatosis was found in 48.3 % of patients with normal L3-SMI.

Conclusion: SM-RA can identify more patients with muscle disorder than L3-SMI and SPPB.

Keywords: cirrhosis; myosteatosis; sarcopenia; short physical performance battery; skeletal muscle index.