Nutritional Status Forecasts Complications for Patients With Late-Stage Cirrhosis

Dr. Cornelius Engelmann

Patients suffering from more severe cirrhosis could be at an increased risk of complications after liver transplantations based on their body fat content.

A team, led by Dr. Cornelius Engelmann, Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, compared different computed tomography (CT)-derived fat parameters for their prognostic impact on the development of complications and mortality prior to and following liver transplantation.

Complications

While treating underlying liver diseases does prevent complications in many patients, some will eventually progress to later stage disease that requires liver transplantation.

For example, cachexia commonly occurs in patients with late stage liver cirrhosis, with research showing low-fat mass could lead to more severe outcomes.

“To reduce the number of deaths and to tailor individual management strategies, it is essential to identify patients at high risk for fatal outcomes and disease-related complications among a cohort with very heterogeneous clinical phenotype, ranging from well-compensated mild cirrhosis to severely decompensated patients with additional organ failures, so-called acute-on-chronic liver failure (ACLF),” the authors wrote.

Looking at Patient Data

In the study, the investigators examined 612 patients with liver cirrhosis without hepatocellular carcinoma listed for liver transplantation between 2001-2014. The study also included 109 patients without cirrhosis as the control group.

The mean age of the patient population with liver cirrhosis was 52 years, compared to the mean age of the control group of 61.7 years (P <0.001).

In addition, among the patients with liver cirrhosis, 63.6% had alcohol-associated liver disease and 66.7% were male.

In addition, 67% of patients suffered from ascites, 80.8% from gastric and/or esophageal varices, and 27.7% had a history of variceal bleeding, while transjugular intrahepatic portosystemic shunt (TIPS) was implanted in 6.7%.

Each participant met the inclusion criteria, which included an abdominal CT scan (±200 days to listing) for body fat content.

Assessing Fat Content

The investigators assessed subcutaneous fat index (SCFI), the paraspinal muscle fat index, and the visceral fat index at the L3/L4 level. They also normalized height.

Overall, the 3 metrics were significantly lower in patients with cirrhosis in comparison to the control group (PSFI: 3.9 ± 2.3 cm²/m² vs. 5.3 ± 3.5 cm²/m²; P = 0.002; SCFI: 56.7 ± 32.2 cm²/m² vs. 69.2 ± 35.4 cm²/m²; P = 0.002; and VFI: 47.6 ± 24 cm²/m² vs. 61.3 ± 33.8 cm²/m²; P <0.001).

The results show low SCFI is linked to a higher rate of ascites, as well as increased C-reactive protein levels (P <0.001). After conducting a multivariate Cox regression analysis adjusting for sex, age, body mass index (BMI), and Model for End-Stage Liver Disease, the investigators found that decreasing SCFI is also associated with an increased risk of cirrhosis-related complications (P = 0.003) and death on the transplant wait list (P = 0.013).

In addition, increased paraspinal and visceral fat were positively correlated with creatinine levels (P <0.001), BMI, and metabolic comorbidities (all P <0.001) both prior to transplantation and predictive for 1-year mortality after transplantation.

“Distinct fat compartments impacted differently on patients’ outcome in cirrhosis,” the authors wrote. “Although a low subcutaneous fat mass increased the risk of death and complications in patients with cirrhosis on the wait list, the risk of complications after liver transplantation was associated with high muscle and visceral fat.”

The investigators suggest considering the nutritional state of patients as a predictor of potential complications that lead to interventions for patients waiting for liver transplants.

The study, “Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis,” was published online in Hepatology Communications.