Influencing Factors And Nutritional Evaluation Value Of Sarcopenia In Patients With Liver Cirrhosis

Objective:To explore the influencing factors and risk factors of sarcopenia in patients with liver cirrhosis,and explore the evaluation value and prognosis of sarcopenia in patients with liver cirrhosis.Methods:A collection of 86 patients with liver cirrhosis who were admitted to our hospital from May 2019 to July 2020 who had undergone abdominal CT examinations were collected as the research objects.The patient’s sex,age,height,weight,etiology of liver cirrhosis,ascites,hepatic encephalopathy and other complications were recorded by clinical history data,and calculation of BMI.Abdominal CT examination and laboratory examination were performed at the same time through the medical record system of our hospital.The circumference of the midpoint of the muscle arm circumference and The Triceps skin fold thickness were measured respectively,and the the mid-upper arm muscle circumference was calculated according to the formula.The sum of all skeletal muscle cross-sectional areas under the cross section of the third lumbar vertebra was delineated and calculated by imaging image processing software,and the L3 skeletal muscle mass index was calculated according to the skeletal muscle mass index formula.The 86 patients with liver cirrhosis who met the inclusion criteria were divided into 2 groups according to the diagnostic criteria of sarcopenia.The correlation between the parameters and the patients with liver cirrhosis complicated with sarcopenia was analyzed.Binary Logistic regression analysis was used to further screen the risk factors of patients with liver cirrhosis complicated with sarcopenia.The sensitivity and specificity of nutritional evaluation indexes such as L3 skeletal muscle mass index,body mass index,the mid-upper arm muscle circumference,triceps skinfold thickness,albumin and lymphocytes were detected by ROC curve,and the area under the curve was calculated.Binary Logistic regression analysis was used to further screen the risk factors of patients with liver cirrhosis complicated with sarcopenia.The sensitivity and specificity of nutritional evaluation indexes such as L3 skeletal muscle mass index,body mass index,upper arm muscle circumference,triceps skinfold thickness,albumin and lymphocytes were detected by ROC curve,and the area under the curve was calculated.Results:1.There were 50 cirrhotic patients with sarcopenia 50(58.14%)and 36 cirrhotic patients without sarcopenia(41.86%).Univariate analysis showed that gender,complications,BMI,L3 skeletal muscle mass index,Child-Pugh grade,upper arm muscle circumference,albumin,fibrinogen,γ-glutamyl transpeptidase,prothrombin time,total bilirubin and direct bilirubin were significantly associated with sarcopenia in patients with liver cirrhosis.(P<0.05)2.Taking sarcopenia as a dependent variable,the results of binary Logistic regression analysis showed that the independent risk factors of sarcopenia in patients with liver cirrhosis were gender(OR=475.13,95%CI(5.92 ~ 38156.45),P<0.05),complication(OR=18.38,95%CI(2.78~39.76),P<0.05 and Child-Pugh grade(OR=20.39,95%CI(1.68 ~ 247.02),P<0.05),respectively.3.The L3 skeletal muscle index in male cirrhotic patients(43.95±6.93cm2/m2)was significantly lower than that in female patients(49.50±9.28cm2/m2).The L3 skeletal muscle index in cirrhotic patients with complications(42.77±6.44cm2/m2)was significantly lower than that in cirrhotic patients without complications(50.16±8.58cm2/m2).The L3 skeletal muscle index of patients with Child-Pugh A,B,and C cirrhosis were 49.87±7.83cm2/m2,43.22±7.96cm2/m2,43.32±7.00cm2/m2。L3 skeletal muscle mass index was significantly lower in Child-Pugh B/C cirrhosis than in Child-Pugh A cirrhosis.4.The area under ROC curve of the L3 skeletal muscle mass index of(AUC=0.85)was significantly higher than that of TSF(AUC=0.54),albumin(AUC=0.51,lymphocyte count(AUC=0.51),MAMC(AUC=0.59)and BMI(AUC=0.68).L3 skeletal muscle mass index has high sensitivity and specificity for the evaluation of nutritional status of patients with liver cirrhosis(sensitivity = 0.62,specificity = 1.00).Conclusion:1.Gender,complication and Child-Pugh grade are independent prognostic risk factors in patients with liver cirrhosis complicated with sarcopenia.The incidence of sarcopenia was higher and the decrease of skeletal muscle mass was more significant in male patients with liver cirrhosis with complications and higher Child-Pugh grade.2.The value of L3 skeletal muscle mass index in evaluating the nutritional status of patients with liver cirrhosis was better than triceps skinfold thickness,albumin,lymphocyte count,AMC and BMI.