New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact

Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis. This study included 51 patients with cirrhosis. We used the frailty scale risk assessme...

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Published inMiddle East journal of digestive diseases Vol. 16; no. 2; pp. 102 - 108
Main Authors El Khoueiry, Christele, Slim, Rita, Rida, Mohammad, Khoury, Bernard, Honein, Khalil, Smayra, Tarek, Yaghi, Cesar
Format Journal Article
LanguageEnglish
Published Iran Shiraz University of Medical Sciences 01.04.2024
Iranian Association of Gastroerterology and Hepatology
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Abstract Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis. This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density. The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE. The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.
AbstractList Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis.BackgroundFrailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis.This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density.MethodsThis study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density.The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE.ResultsThe L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE.The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.ConclusionThe L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.
Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis. This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density. The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE. The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.
CFS is a predictor of increased mortality in outpatient patients with cirrhosis regardless of muscle mass (hazard ratio 1.534, P=0.007).8 For the hospital inpatients, a CFS higher than 4, was an independent predictor for the 28 days mortality (mortality of 30.7% for hospital inpatients with a CFS higher than 4 and 19.1% for those with a CFS lower than 4).8 A high CFS is associated with increased rates of unplanned hospitalization (57% frail vs. 24% not frail, adjusted odds ratio 3.6, P=0.0008), high risk of acute kidney injury (3.7-fold risk increase with a CFS higher than 4), or death.7,9,10 The liver frailty index (LFI) includes the sex-adjusted HGS, chair stands, and balance. Patients with cirrhosis and sarcopenia have a lower quality of life due to the loss of muscle mass or due to the increased risks of sepsis and other complications of cirrhosis.18 There is no established gold standard for the diagnosis of sarcopenia in patients with cirrhosis. The diagnostic cutoffs are extrapolated from oncology patients:<38.5 cm/ m2 for women and<52.4 cm/m2 for men.16 The ascites and edema in patients with cirrhosis do not seem to affect the skeletal muscle index, especially if combined with the HGS.19 In both cirrhosis and frailty, we note a state of chronic inflammation (after the elevation of TNF-α and interleukin-6) that can lead to the disturbance of the homeostatic balance between myocyte production, destruction and hypertrophy and thereafter, muscle breakdown.2 Therefore, the destruction of the muscle is accompanied by higher fat content in the muscle, higher muscle wall area, and lower density on the CT scan; thus, we talk about myosteatosis. Data Collection The patients filled out a questionnaire containing the demographic and anthropometric characteristics (body mass index [BMI], age, sex), the etiology and complications of the cirrhosis (ascites, encephalopathy, Child-Pugh score and the MELD sodium), and the latest blood test (creatinine, albumin, bilirubin, sodium, international normalized ratio).
Author Khoury, Bernard
El Khoueiry, Christele
Yaghi, Cesar
Rida, Mohammad
Smayra, Tarek
Slim, Rita
Honein, Khalil
AuthorAffiliation 1 Hotel Dieu de France Hospital, Beirut, Lebanon
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Issue 2
Keywords Cirrhosis
Frailty
Score
Prognostic
Language English
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Iranian Association of Gastroerterology and Hepatology
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Snippet Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic...
CFS is a predictor of increased mortality in outpatient patients with cirrhosis regardless of muscle mass (hazard ratio 1.534, P=0.007).8 For the hospital...
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StartPage 102
SubjectTerms Ascites
Body fat
Chronic fatigue syndrome
Etiology
Frailty
Health risk assessment
Liver cirrhosis
Medical imaging
Medical prognosis
Mortality
Musculoskeletal system
Original
Risk assessment
Sarcopenia
Survival analysis
Tomography
Variables
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Title New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact
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