MRI-defined sarcopenia predicts mortality in patients with chronic liver disease.

BACKGROUND & AIMS To explore whether sarcopenia, diagnosed by an abbreviated magnetic resonance imaging (MRI) protocol is a risk factor for hepatic decompensation and mortality in patients with chronic liver disease (CLD). METHODS In this retrospective single-center study we included 265 patients (164 men, mean age 54 ±16 years) with CLD who had undergone MRI of the liver between 2010-2015. Transverse psoas muscle thickness (TPMT) was measured on unenhanced and contrast-enhanced T1-weighted and T2-weighted axial images. Sarcopenia was defined by height-adjusted and gender-specific cut-offs in women as TPMT <8mm/m and in men as TPMT <12mm/m, respectively. Patients were further stratified into three prognostic stages according to the absence of advanced fibrosis (FIB-4<1.45, non-advanced CLD), compensated-advanced CLD (cACLD); and decompensated-advanced CLD (dACLD). RESULTS The inter-observer agreement for the TPMT measurements (κ=0.98; 95% confidence-interval [95%CI]:0.96-0.98), as well as the intra-observer agreement between the three image sequences (κ=0.99; 95%CI:0.99-1.00) were excellent. Sarcopenia was not predictive of first or further hepatic decompensation. In patients with cACLD and dACLD, sarcopenia was a risk factor for mortality (cACLD: hazard ratio (HR):3.13, 95%CI:1.33-7.41,P=0.009; dACLD:HR:2.45,95%CI:1.32-4.57,P=0.005) on univariate analysis. After adjusting for the model of end-stage liver disease (MELD) score, albumin, and evidence of clinical significant portal hypertension, sarcopenia (adjusted HR: 2.76, 95%CI: 1.02-7.42, p = 0.045) remained an independent risk factor for mortality in patients with cACLD. CONCLUSION Sarcopenia can be easily evaluated by a short MRI exam without the need for contrast injection. Sarcopenia is a risk factor for mortality, especially in patients with cACLD.