P343 Lower psoas muscle density, a proxy for sarcopenia, associates with 30-day mortality in patients with acute variceal bleeding

• Published in: Gut Vol. 73; no. Suppl 1; p. A260
• Main Authors: Leon, Dylan, Tyson, Luke, Krawczyk, Jedrzej, Haq, Taha, Saba, Dana, Thomas, Robert, Dhar, Ameet
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.06.2024; BMJ Publishing Group LTD
• Subjects: Albumin; Bilirubin; Bleeding; Cirrhosis; Clotting; Computed tomography; Liver cirrhosis; Liver diseases; Mortality; Nutritional status; Patients; Poster Presentations; Proteins; Psoas muscle; Risk factors; Sarcopenia; Sensitivity analysis
• DOI: 10.1136/gutjnl-2024-BSG.425
• ISSN: 0017-5749

IntroductionAcute variceal bleeding (AVB) is associated with high mortality in patients with cirrhosis. Liver function is inversely associated with outcome after AVB; higher disease severity scores are associated with higher 30-day mortality. Sarcopenia is associated with increased mortality in cirrhosis, but it is unclear whether sarcopenia is an independent risk factor for mortality after AVB. This service evaluation aimed to identify factors associated with mortality after AVB, including measures of psoas muscle density as a proxy for sarcopenia.MethodsPatients admitted to Imperial College Healthcare Trust hospitals with suspected AVB 01/05/2020 to 30/09/2022 were retrospectively included. Baseline demographics, clinical parameters, interventions, and outcome measures including 30-day mortality were recorded. Psoas muscle measurements were made from CT scans within 3-months of AVB. Associations were tested by binary logistic regression; correlation by Spearman’s Rank; p-values were adjusted for multiple comparisons by the Benjamini-Hochberg procedure.ResultsOf 120 suspected AVB, 104 were confirmed endoscopically. In suspected AVB, baseline MELD (odds ratio, OR 1.15, 1.07–1.12, P = 0.001), serum bilirubin (OR 1.01, 1.00–1.01, P = 0.004), serum albumin (OR 0.87, 0.79–0.95, P = 0.02), administration of clotting products (OR = 5.18, 1.68- 15.93, P=0.027) and Psoas HU (0.93, 0.88–0.98, P=0.044) were associated with 30-day mortality. Baseline serum albumin and Psoas Hu were associated with mortality when adjusted for baseline MELD (adjusted OR, AOR 0.903, 0.816–0.998, P = 0.046; AOR 0.920, 0.861–0.982, P = 0.036, respectively). As a sensitivity analysis, only patients with a CT scan within seven days after a confirmed variceal bleed were included (54 patients; 5 deaths): Psoas HU remained significantly associated with mortality independent of MELD (AOR 0.893, 0.809 - 0.986, P = 0.025). Psoas HU did not correlate with MELD or bilirubin.ConclusionsLower psoas muscle HU, a recognised measure of psoas muscle density and nutritional status, is associated with higher 30-day mortality post AVB independent of baseline liver disease severity, represented by MELD score. This association should be confirmed prospectively. If confirmed, early nutritional intervention could be trialled in at risk patients post AVB.