Limited performance of subjective global assessment compared to computed tomography-determined sarcopenia in predicting adverse clinical outcomes in patients with cirrhosis

Carlos Moctezuma-Velazquez; Maryam Ebadi; Rahima A Bhanji; Guido Stirnimann; Puneeta Tandon; Aldo J Montano-Loza

doi:10.1016/j.clnu.2018.11.024

Limited performance of subjective global assessment compared to computed tomography-determined sarcopenia in predicting adverse clinical outcomes in patients with cirrhosis

Clin Nutr. 2019 Dec;38(6):2696-2703. doi: 10.1016/j.clnu.2018.11.024. Epub 2018 Nov 30.

Authors

Carlos Moctezuma-Velazquez¹, Maryam Ebadi¹, Rahima A Bhanji¹, Guido Stirnimann², Puneeta Tandon¹, Aldo J Montano-Loza³

Affiliations

¹ Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
² Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada; Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
³ Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada. Electronic address: montanol@ualberta.ca.

PMID: 30545661
DOI: 10.1016/j.clnu.2018.11.024

Abstract

Background & aims: The subjective global assessment (SGA) is commonly used to assess nutritional status in patients with cirrhosis. Sarcopenia, a major component of malnutrition, is associated with survival in cirrhosis, and can be objectively diagnosed by computing the skeletal muscle index (SMI) using cross-sectional imaging. The aim of this study was to assess the prevalence of sarcopenia between SGA categories in patients with cirrhosis, and to determine their association with decompensation/mortality.

Methods: We included 315 patients (66% males) who were assessed for liver transplantation. All patients had SGA and SMI, and were evaluated for the presence of hepatic encephalopathy (HE) and ascites.

Results: Mean age was 54 ± 8 years. SGA categories were 126 SGA A (40%), 155 SGA B (49%), 34 SGA C (11%). Sarcopenia was present in 121 (38%) patients; of these, 82% were SGA A/B. Of SGA A patients, 25 (20%) had sarcopenia. There was a significant but only weak concordance between sarcopenia and SGA B/C (κ = 0.28, p < 0.001), and SGA C (κ = 0.13, p < 0.001). The latter was lost in overweight/obese patients. SGA B/C was associated with HE (OR 2.8, p = 0.01) and ascites (OR 2.3, p = 0.002). Median survival was shorter in patients with sarcopenia (20 [IQR 15.9-24.5] vs. 42 [IQR: 25.8-58.9] months, p < 0.001) and in SGA C patients (9.4 [IQR: 0-26.2] vs. 33 [IQR 20.2-45.7] months, p = 0.01). In univariate analysis both sarcopenia and SGA C were associated with mortality, but sarcopenia was the only factor that remained significant on multivariate analysis.

Conclusions: There was only a weak concordance between SGA and sarcopenia. This concordance was non-significant in patients who were overweight/obese. Sarcopenia was associated with mortality, whereas SGA was not. Sarcopenia by the SMI is a more efficient method to predict adverse outcomes in a timely fashion and has prognostic implications.

Keywords: End stage liver disease; Hepatic encephalopathy; Liver transplantation; Muscular atrophy; Nutritional status.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Hepatic Encephalopathy
Humans
Hypertension, Portal
Liver Cirrhosis* / complications
Liver Cirrhosis* / epidemiology
Liver Cirrhosis* / mortality
Liver Cirrhosis* / therapy
Liver Transplantation
Male
Middle Aged
Nutrition Assessment
Nutritional Status / physiology*
Prognosis
Retrospective Studies
Sarcopenia* / diagnosis
Sarcopenia* / epidemiology
Sarcopenia* / etiology
Sarcopenia* / mortality
Tomography, X-Ray Computed