AbstractBackgroundSarcopenia has been reported as a prognostic factor. We evaluated the impact of sarcopenia to the conventional prognostic factors [Model for End‐Stage Liver Disease (MELD) score, Child–Turcotte–Pugh (CTP) score, hepatic venous pressure gradient (HVPG)] in cirrhosis.MethodsOverall, 452 patients with cirrhosis were stratified by MELD score (low < 15, high ≥ 15), CTP class, and HVPG [non‐clinically significant portal hypertension (CSPH), 6–9 mmHg; CSPH, 10–19 mmHg; extremely severe PH, ≥20 mmHg]. L3 skeletal muscle index as marker of sarcopenia was subdivided into quartiles (47.01–52.25–58.22 cm2/m2).ResultsAmong the patients, 42% (190/452) presented with sarcopenia. During a median follow‐up period of 21.2 months, sarcopenia was associated with mortality (adjusted hazard ratio = 2.253, P < 0.001) and specifically with compensated and early decompensated stages of cirrhosis, but not with advanced decompensated stages; low (P < 0.001) and high (P = 0.095) MELD scores; CTP classes A (P = 0.034), B (P < 0.001), and C (P = 0.205); and non‐CSPH (P = 0.018), CSPH (P < 0.001), and extremely severe PH (P = 0.846). In quartiles of sarcopenia, MELD score, CTP class, and HVPG were independent predictors of mortality in non‐sarcopenia, but not in severe sarcopenia (MELD, P = 0.182; CTP, P = 0.187; HVPG, P = 0.077).ConclusionsSarcopenia is associated with mortality in compensated and early decompensated cirrhosis, and existing conventional prognostic factors had limited value in severe sarcopenia. Therefore, incorporating sarcopenia in the conventional prognostic factors had added value, particularly in compensated and early decompensated cirrhosis. Subclassification of prognostic factors according to sarcopenia may help to better assess the prognosis of cirrhosis.

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肌肉减少症对肝硬化预后价值的影响：超越肝静脉压力梯度和 MELD 评分

摘要背景据报道，肌肉减少症是一个预后因素。我们评估了肌少症对肝硬化常规预后因素[终末期肝病模型（MELD）评分、Child-Turcotte-Pugh（CTP）评分、肝静脉压力梯度（HVPG）]的影响。方法总体而言，452 名肝硬化患者根据 MELD 评分（低 < 15，高 ≥ 15）、CTP 分级和 HVPG [非临床显着性门静脉高压 (CSPH)，6-9 mmHg；CSPH，10–19 毫米汞柱；极其严重的 PH，≥20 mmHg]。作为肌肉减少症标志的 L3 骨骼肌指数被细分为四分位数（47.01–52.25–58.22 cm）2/米2）。结果在这些患者中，42% (190/452) 出现肌肉减少症。在中位随访 21.2 个月期间，肌肉减少症与死亡率相关（调整后的风险比 = 2.253，磷< 0.001），特别是肝硬化的代偿期和早期失代偿期，但不包括晚期失代偿期；低的 （磷< 0.001) 和高 (磷= 0.095) MELD 分数；CTP A 级（磷= 0.034), B (磷< 0.001), 和 C (磷= 0.205); 和非 CSPH（磷= 0.018), CSPH (磷< 0.001)，以及极其严重的 PH (磷= 0.846）。在肌少症四分位数中，MELD 评分、CTP 等级和 HVPG 是非肌少症患者死亡率的独立预测因子，但对于重度肌少症患者则不然（MELD、磷= 0.182；连拍、磷= 0.187; 高压气相色谱仪,磷= 0.077)。结论肌肉减少症与代偿期和早期失代偿性肝硬化的死亡率相关，现有的常规预后因素对于严重肌肉减少症的价值有限。因此，将肌肉减少症纳入常规预后因素具有附加价值，特别是在代偿期和早期失代偿性肝硬化中。根据肌少症对预后因素进行细分可能有助于更好地评估肝硬化的预后。