Relationship between skeletal muscle index at the third lumbar vertebra with infection risk and long-term prognosis in patients with acute-on-chronic liver failure

Juan Wang; Jinjia Bai; Huimin Wang; Guofen Xu; Ruoyu Yao; Jing Li; Wenrui Zhang; Han Wang; Jia Yao; Xiaojing Ren

doi:10.3389/fnut.2023.1327832

Relationship between skeletal muscle index at the third lumbar vertebra with infection risk and long-term prognosis in patients with acute-on-chronic liver failure

Front Nutr. 2024 Jan 10:10:1327832. doi: 10.3389/fnut.2023.1327832. eCollection 2023.

Authors

Juan Wang^#¹, Jinjia Bai^#¹, Huimin Wang², Guofen Xu³, Ruoyu Yao¹, Jing Li¹, Wenrui Zhang¹, Han Wang¹, Jia Yao¹, Xiaojing Ren¹

Affiliations

¹ Department of Gastroenterology, Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital), Shanxi Medical University, Taiyuan, China.
² Endoscopy Center, Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China.
³ Department of Gastroenterology, Jincheng General Hospital, Shanxi Medical University, Taiyuan, China.

^# Contributed equally.

Abstract

Objective: Infection is a major cause of increased mortality in patients with acute-on-chronic liver failure (ACLF). This study aims to examine the potential correlation of the skeletal muscle index at the third lumbar vertebra (L3-SMI) with infections among ACLF patients and to evaluate its impact on the long-term survival.

Methods: This retrospective study included 126 patients who underwent abdominal computed tomography (CT) and were diagnosed with ACLF at our center between December 2017 and December 2021. L3-SMI was calculated using CT, and the clinical and biochemical data as well as MELD scores were also collected, so as to analyze the relationship between L3-SMI and infections in ACLF patients and the impact on long-term prognosis.

Results: Of the 126 ACLF patients enrolled, 50 had infections. In the multivariate logistic regression analysis, both L3-SMI [odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.81 - 0.97, P = 0.011] and hepatic encephalopathy (OR = 8.20, 95% CI = 1.70 - 39.59, P = 0.009) were independently associated with the risk of infection development. The overall survival (OS) estimates were obtained using Kaplan-Meier curves, and it was found that patients in the lowest tertile of L3-SMI had significantly lower 3-month, 6-month, 1-year, and 2-year survival rates than those in the highest tertile (P = 0.014; log-rank test).

Conclusion: Low L3-SMI is an independent risk factor for the development of infections and significantly influences the long-term survival in ACLF patients.

Keywords: acute-on-chronic liver failure; infection; long-term survival rate; low skeletal muscle index; sarcopenia.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of the article. The present study was supported by the Shanxi Province Basic Research Program (202103021224341, 202203021222342, and 202303021212328), Shanxi Provincial Healthy Commission Guiding Science and Technology Project (2021XM42), Endocrine and metabolic diseases key laboratory of Shanxi Province (202104010910009).