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Open Access 01-12-2024 | Sarcopenia | Research

Imaging-based diagnosis of sarcopenia for transplant-free survival in primary sclerosing cholangitis

Authors: Pedram Keshoofi, Philipp Schindler, Florian Rennebaum, Friederike Cordes, Haluk Morgul, Moritz Wildgruber, Hauke S. Heinzow, Andreas Pascher, Hartmut H. Schmidt, Anna Hüsing-Kabar, Michael Praktiknjo, Jonel Trebicka, Leon Louis Seifert

Published in: BMC Gastroenterology | Issue 1/2024

Abstract

Background

Imaging-based assessment of sarcopenia is a well-validated prognostic tool for patients with chronic liver disease. However, little is known about its value in patients with primary sclerosing cholangitis (PSC). This cross-sectional study aimed to investigate the predictive value of the cross-sectional imaging-based skeletal muscle index (SMI) for transplant-free survival (TFS) in patients with PSC.

Methods

A total of 95 patients with PSC who underwent abdominal cross-sectional imaging between 2008 and 2022 were included in this retrospective study. SMI was measured at the third lumbar vertebra level (L3-SMI). The cut-off values to define sarcopenia were < 50 cm²/m² in male patients and < 39 cm²/m² in female patients. The primary outcome of this study was TFS, which was defined as survival without liver transplantation or death from any cause.

Results

Our study indicates that L3-SMI sarcopenia impairs TFS in patients with PSC (5-year TFS: 33.9% vs. 83.3%, p = 0.001, log-rank test). L3-SMI sarcopenia was independently associated with reduced TFS via multivariate Cox regression analysis (HR = 2.749; p = 0.028). Body mass index reduction > 10% at 12 months, which is used as MELD standard exception (SE) criterion in Eurotransplant (in Germany only until September 2023), was not significantly associated with TFS in the multivariate Cox regression analysis (HR = 1.417; p = 0.330). Substitution of BMI reduction with L3-SMI in the German SE criteria improved the predictive accuracy of TFS compared to the established SE criteria (multivariable Cox regression analysis: HR = 4.007, p < 0.001 vs. HR = 1.691, p = 0.141).

Conclusion

Imaging-based diagnosis of sarcopenia via L3-SMI is associated with a low TFS in patients with PSC and may provide additional benefits as a prognostic factor in patient selection for liver transplantation.

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Title: Imaging-based diagnosis of sarcopenia for transplant-free survival in primary sclerosing cholangitis
Authors: Pedram Keshoofi
Philipp Schindler
Florian Rennebaum
Friederike Cordes
Haluk Morgul
Moritz Wildgruber
Hauke S. Heinzow
Andreas Pascher
Hartmut H. Schmidt
Anna Hüsing-Kabar
Michael Praktiknjo
Jonel Trebicka
Leon Louis Seifert
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Sarcopenia
Primary Sclerosing Cholangitis
Published in: BMC Gastroenterology / Issue 1/2024
Electronic ISSN: 1471-230X
DOI: https://doi.org/10.1186/s12876-024-03232-9

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