Myosteatosis for Early Detection of Muscle Disorder in Patients With Liver Cirrhosis

Background and aims: Muscle disorders in cirrhosis are associated with poor outcome and need early identification. Anthropometric measures lack sensitivity, and CT-based L3-skeletal muscle Index (L3-SMI) may miss early sarcopenia. The study aimed to find if SM-RA can identify more patients with muscle disorder than L3-SMI and anthropometry. Methods: 388 patients with cirrhosis underwent nutritional assessment by anthropometry, short-physical-performance-battery (SPPB) < 9, L3-SMI (<36.5 cm(2)/m(2) (males); <30.2 cm(2)/m(2) (females), and myosteatosis assessment by skeletal muscle radiation attenuation (SM-RA) (<41 HU for body mass index [BMI] <24.9 kg/m(2) and <33 HU for >= 25 kg/m(2)) and results were compared. Results: Sarcopenia based on SPPB was 38.9 % with scores (9 +/- 1.48 vs. 10.74 +/- 1.25, P = 0.001 in males; and 8.43 +/- 1.59 vs. 9.89 +/- 1.57, P = 0.001 in females). Mid-arm muscle circumference was lower in sarcopenic males [20.5 +/- 2.42 vs. 22.9 +/- 2.19 cm, P = 0.001] but not in females [19.4 +/- 2.73 vs. 21.1 +/- 2.51, P = 0.18]. L3-SMI-based sarcopenia was found in 44.8 % (additional 5.92 %) compared to SPPB, mostly in cryptogenic cirrhosis (19.2 % vs. 35.08 %, delta change +15.9 %). Myosteatosis (71.64 %) identified an additional 26.85 % and 32.74 % of patients with muscle disorder compared to L3SMI and SPPB, respectively, with the majority of new detection in non-alcoholic fatty liver disease (NAFLD) 39.4 % vs. 77.06 %, delta change +37.66 %) CTP-A patients (16.6 % vs. 36.8 %, delta change +20.2 %). Myosteatosis was found in 48.3 % of patients with normal L3-SMI. Conclusion: SM-RA can identify more patients with muscle disorder than L3-SMI and SPPB.