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Sex is a major effect modifier between body composition and mortality in patients with cirrhosis assessed for liver transplantation

Benmassaoud, Amine; Roccarina, Davide; Arico, Francesco Marcello; Marta, Cilla; Donghia, Rossella; Leandro, Gioacchino; Prat, Laura Iogna; ... Tsochatzis, Emmanuel A; + view all (2023) Sex is a major effect modifier between body composition and mortality in patients with cirrhosis assessed for liver transplantation. Liver International , 43 (1) pp. 160-169. 10.1111/liv.15293. Green open access

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Abstract

Background and Aims: Body composition predicts mortality in patients with cirrhosis. The impact of sex on this association is unknown. We investigated the impact of sex on this association in patients with cirrhosis assessed for liver transplantation. / Methods: This single-centre retrospective cohort study included adults assessed for liver transplantation. Nutritional status was assessed using the Royal Free Hospital-Global Assessment (RFH-GA). Body composition at the third lumbar vertebrae was determined. SarcopeniaSMI was defined as Skeletal Muscle Index <50 cm2/m2 in males and <39 cm2/m2 in females. SarcopeniaPMI was defined as the sex-specific 25th percentile of the Psoas Muscle Index. Patients were assessed for the occurrence of liver transplantation and death. Analyses were stratified by sex. / Results: The cohort comprised 628 patients, including 199 females and 429 males. Both groups were similar in terms of baseline liver disease severity by Model for End-stage Liver Disease (MELD) (p =.98) and nutritional status (p =.24). SarcopeniaSMI was present in 41% of males compared to 27% of females (p <.001). In the male cohort, when adjusted for age and MELD, sarcopeniaPMI (aHR 1.74, 95% CI 1.08–2.80) and RFH-GA (aHR 1.40, 95% CI 1.03–1.90) remained independent predictors of mortality. Adipose tissue had no impact on outcomes in males. In female patients, adipose tissue (TATI or VATI depending on the multivariable model) was independently associated with mortality, whereas sarcopenia and malnutrition were not. / Conclusions: This study demonstrates that male patients were susceptible to low muscle mass, whereas female patients were not. Future research in this patient population should minimize sex-related bias and present data for both groups separately.

Type: Article
Title: Sex is a major effect modifier between body composition and mortality in patients with cirrhosis assessed for liver transplantation
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/liv.15293
Publisher version: https://doi.org/10.1111/liv.15293
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: adipose tissue, cirrhosis, liver transplantation, malnutrition, sarcopenia, sex
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10154050
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