Study On The Influencing Factors And Correlation Of Sarcopenia And Myosteatosis In Liver Cirrhosis

Objective(s): Sarcopenia and myosteatosis are both manifestations of muscle abnormalities,which are related to the adverse outcomes of patients with cirrhosis.The existing research on the muscles of patients with liver cirrhosis mostly focuses on the study of muscle mass,which is known as sarcopenia.Its pathogenesis and diagnostic methods are still unclear;Myosteatosis is an index reflecting the quality of skeletal muscle.However,few studies have been carried out at present.It is rarely reported in China.Its pathogenesis,diagnosis and treatment still need to be explored.This study first compares the diagnostic value of different measurement indicators for sarcopenia,hoping to identify simple diagnostic indicators for sarcopenia;At the same time,the influencing factors of liver cirrhosis complicated with sarcopenia and myosteatosis were analyzed to guide clinical practice;In addition,correlation analysis is conducted to provide a basis for exploring the pathogenesis.Methods: Collect 176 liver cirrhosis patients who met the inclusion and exclusion criteria and were hospitalized at the Second Affiliated Hospital of Kunming Medical University from January 2022 to December 2022 and were able to cooperate in completing effective investigations as the research subjects.According to the skeletal muscle index of the third lumbar vertebrae measured by CT images,patients were divided into a sarcopenia group(n=96)and a non sarcopenia group(n=80).The clinical data of the two groups were compared,and the diagnostic value of anthropometric indicators and nutritional assessment scales for sarcopenia was analyzed by plotting ROC curves.The influencing factors of liver cirrhosis complicated with sarcopenia were analyzed using logistic regression;In addition,the patients were divided into myosteatosis group(n=99)and non myosteatosis group(n=77)through the average attenuation coefficient of the skeletal muscle of the third lumbar spine;At the same time,the correlation analysis was used to explore the relationship between sarcopenia and myosteatosis and various clinical indicators.Results: 1.There were significant differences in age,etiology,and bleeding incidence among the sarcopenia group(P<0.05).The group with sarcopenia is older and has a higher incidence of bleeding.Patients with immune cirrhosis are more likely to develop sarcopenia than other causes.The dry BMI,obesity incidence,TPTI,SMA,SMI,MAC,SFA,grip strength,upper arm circumference,calf circumference,TSF,AMC,CAP,hemoglobin,CK,CK-MB,PT,INR,APTT,MELD scores in the sarcopenia group were significantly lower than those in the non sarcopenia group(P<0.05),and myosteatosis,uric acid,DD,CRP,PLR were significantly higher than those in the non sarcopenia group(P<0.05).2.There was no significant difference in the occurrence of sarcopenia among different CTP grades(P>0.05).The NRS-2002 score,RFH-NPT score,and PG-SGA score of the sarcopenia group were significantly higher than those of the non sarcopenia group(P<0.05);Patients with high nutritional risk are more likely to develop sarcopenia.3.The ROC curve of the diagnostic value of anthropometric indicators for sarcopenia:(1)For males,the AUC of grip strength,upper arm circumference,calf circumference,TSF,and AMC were 0.702,0.816,0.723,0.695,and 0.786,respectively(P<0.05);(2)Female: The AUC of grip strength,upper arm circumference,calf circumference,TSF,and AMC were 0.655,0.723,0.728,0.581,and 0.731,respectively.All other indicators except for TSF were statistically significant(P<0.05).4.The ROC curve of the predictive value of the nutritional assessment scale for sarcopenia: the AUC of NRS-2002 score,RFH-NPT score,and PG-SGA score were0.702,0.618,and 0.666,respectively(P<0.05).5.Multivariate logistic regression analysis showed that SFA and SMA were protective factors for liver cirrhosis complicated with sarcopenia;Uric acid and NRS-2002 have nutritional risks,and myosteatosis is the risk factor.6.There were significant differences in age,sex and etiology between myosteatosis group and non myosteatosis group(P<0.05).Myosteatosis is more common in women and older people.Compared with cirrhosis of other causes,alcoholic cirrhosis and immune cirrhosis are more likely to have myosteatosis.The dry BMI,TPTI,SMA,SMI,MAC,grip strength,upper arm circumference,calf circumference,AMC,hemoglobin,albumin,creatinine,MELD scores of myosteatosis group were significantly lower than those of non myosteatosis group(P<0.05),while VFA,ALP,GGT,LDH,HBDH,TC,DD,CRP were significantly higher than those of non myosteatosis group(P<0.05).7.There was no difference in the occurrence of myosteatosis in different CTP grades(P>0.05).The NRS-2002 score,RFH-NPT score and PG-SGA score of myosteatosis group were significantly higher than those of non myosteatosis group(P<0.05),and patients with high nutritional risk were more prone to myosteatosis.8.Multivariate logistic regression analysis showed that SMI was the protective factor of liver cirrhosis complicated with myosteatosis;Age,ALP,HBDH,and VFA are risk factors for it.9.(1)SMI was positively correlated with SMA,MAC,VFA,grip strength,upper arm circumference,calf circumference,TSF,AMC,TPTI,dry BMI,ICGR15,LSM,CAP,hemoglobin,CK,creatinine,iron,PT,INR,APTT,MELD scores(P<0.05),and negatively correlated with age,PLR,ALP,TC,FIB,NRS-2002 scores,and PG-SGA scores(P<0.05).(2)SMA was positively correlated with SMI,MAC,VFA,grip strength,upper arm circumference,calf circumference,TSF,AMC,TPTI,dry BMI,ICGR15,LSM,CAP,white blood cells,hemoglobin,CK,creatinine,iron,PT,INR,APTT,TT,MELD scores(P<0.05),and negatively correlated with age,PLR,TC,magnesium,FIB,NRS-2002 scores,and PG-SGA scores(P<0.05).(3)MAC was positively correlated with SMI,SMA,grip strength,TPTI,EHBF,hemoglobin,albumin,and MELD scores(P<0.05),while negatively correlated with VFA,SFA,age,ALP,GGT,LDH,HBDH,DD,IL-6,CTP scores,NRS-2002 scores,RFH-NPT scores,and PG-SGA scores(P<0.05).Conclusion(s): 1.The incidence of sarcopenia in patients with liver cirrhosis is relatively high.Upper arm circumference can be a simple diagnostic method for sarcopenia in male liver cirrhosis patients,and upper arm muscle circumference can be a simple diagnostic method for sarcopenia in female liver cirrhosis patients.NRS-2002 has higher diagnostic value for sarcopenia than RFH-NPT and PG-SGA.2.Increased uric acid,nutrition risk in NRS-2002 screening and myosteatosis are the risk factors of liver cirrhosis complicated with sarcopenia,and increased subcutaneous fat area and skeletal muscle area are the protective factors.3.Liver cirrhosis patients are prone to myosteatosis,and myosteatosis is mainly manifested by the decline of muscle strength;Age,increased ALP,increased HBDH and increased visceral fat area are the risk factors of liver cirrhosis complicated with myosteatosis,while increased SMI is the protective factor.4.Myosteatosis and sarcopenia are related to the nutritional status of patients with liver cirrhosis.Malnourished patients need to be alert to the occurrence of sarcopenia or myosteatosis.5.There is a positive correlation between liver cirrhosis sarcopenia and the occurrence of myosteatosis.The inflammatory indicators in both the sarcopenia group and the myosteatosis group are high,suggesting that inflammation may be one of the potential mechanisms of their association.