Muscle volume loss a prognostic factor for death in liver cirrhosis patients and special relationship to portal hypertension

作者：Hiraoka Atsushi^*; Kitahata Shogo; Izumoto Hirofumi; Ueki Hidetaro; Aibiki Toshihiko; Okudaira Tomonari; Miyamoto Yuji; Yamago Hiroka; Iwasaki Ryuichiro; Tomida Hideomi; Mori Kenichiro; Kishida Masato; Tsubouchi Eiji; Miyata Hideki; Ninomiya Tomoyuki; Hirooka Masashi; Tokumoto Yoshio; Abe Masanori; Matsuura Bunzo; Hiasa Yoichi; Michitaka Kojiro

来源：Hepatology Research, 2018, 48(3): E354-E359.

DOI：10.1111/hepr.12984

• esophagogastric varices
• liver cirrhosis
• muscle volume loss
• portal hypertension
• prognosis

Aim: We examined the prognosis of liver cirrhosis (LC) patients with and without portal hypertension (PHT) and muscle volume loss (MVL).
Methods: From 2006 to 2016, 346 LC outpatients (PHT/non-PHT = 173/173) were enrolled (median age, 69 years; men/women, 204/142; Child-Pugh A/B, 230/116; and presence of MVL 15.6% in each group) after propensity matching, following exclusion of those with hepatocellular carcinoma (HCC) beyond the Milan criteria and Child-Pugh C. Portal hypertension was defined as positive for significant esophagogastric varices; MVL was diagnosed based on a previously reported index using CT imaging. Overall survival rate (OSR) was evaluated from the viewpoints of PHT and MVL.
Results: There were no significant differences in clinical background (age, gender, etiology, presence of HCC [within Milan criteria], or Child-Pugh class) between the groups. Although there was no significant difference regarding OSR between patients with and without MVL in the non-PHT group (P = 0.076, Holm's method), the OSR of patients with MVL in the PHT group was lower compared to those without MVL in both groups (P = 0.017 and P = 0.012, respectively, Holm's method). As a result, the OSR of patients with MVL (n = 54) was lower than the other patients (n = 292) (3-and 5-year OSR, 69.0% vs. 86.4% and 35.8% vs. 74.1%, respectively; P<0.001). Multivariate Cox hazard analysis showed that positive for HCC (hazard ratio [HR], 2.028; 95% confidence interval [CI], 1.189-3.460; P = 0.009) and positive for MVL (HR, 2.768; 95% CI, 1.575-4.863; P< 0.001)were significant independent prognostic factors for death.
Conclusion: Muscle volume loss and HCC, but not PHT, were found to be independent prognostic factors for death in LC patients.

• 出版日期2018-2