Psoas Muscle Density Improves Survival Predictability Following TIPS
AASLD LiverLearning®. Shoreibah M. Nov 14, 2016; 144606
Topic: Portal Hypertension and Other Complications of Cirrhosis
Mohamed Shoreibah
Mohamed Shoreibah

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TITLE: Psoas Muscle Density Improves Survival Predictability Following TIPS


Purpose: Cirrhosis is associated with both loss of muscle mass and decreased muscle density. These changes are associated with increased mortality in patients with cirrhosis. The aim of this study was to examine the role of pre-TIPS psoas muscle density (PD) measurement in predicting survival when combined with MELD score. Methods:We retrospectively reviewed the medical records of 216 patients who had TIPS from June 2005 and June 2015. The patients were separated into two groups; group A (n=106) and group B (n=110), who had TIPS for variceal bleed (VB), and refractory ascites (RA) respectively. PD was measured on a non-contrast CT in Hounsfield Units (HU) prior to TIPS, and pre-TIPS MELD score was calculated. The primary endpoint was to determine a threshold sensitivity of pre-TIPS PD for assessing mortality in each group and measure its correlation with survival following TIPS. The secondary endpoint was to determine if combining the PD threshold with MELD score can improve survival predictability following TIPS, compared to MELD score alone. Logistic regression and Youden’s J criteria were used for identifying optimum PD thresholds among patients in both groups. Receiver Operating Characteristics and differences between the area under the curve (AUC) were assessed for MELD score alone compared to MELD score and PD thresholds. Cox regression analysis was performed. Results:The study included 62% males, 69% Caucasians, age 56 yrs. (SD=10), and had MELD score of 12.4 (SD=7.5). There was no significant difference in the baseline characteristics between the two groups. The PD threshold for discriminating mortality at 12 and 48 monthswas 43.47 HU(p=0.0618) for group A and 49.44 HU(p=0.0132) for group B. PD below these thresholds was associated with higher risk of mortality at 12 and 48 months [HR=2.4,CI(1.5, 3.9),p=0.0005]. Using both the PD threshold and MELD score resulted in a significantly better discriminative capability in predicting survival at 12 months (AUC=0.73,p=0.002)and 48 months (AUC=0.72,p=0.001), compared to using each individually (Likelihood Ratio,p<0.05).Conclusion:When used in conjunction with MELD score, PD improves survival predictability following TIPS at 12 and 48 months. The best survival outcome was reported in patients with MELD<15, PD>43.47 HU for VB and PD>49.44 HU for RA.

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