Sarcopenia is a frequent and prognostically-relevant complication in patients with porto-sinusoidal vascular disorder

Background In cirrhotic patients, sarcopenia is an important comorbidity, often associated with increased morbidity/mortality. A link between sarcopenia and porto-sinusoidal vascular disorder (PSVD) has yet not been described. We investigated the prevalence and prognostic impact of sarcopenia in PSVD patients.

Materials and methods Patients with histologically proven PSVD managed at the Vienna General Hospital between 2001-2021 were eligible. Sarcopenia was defined by transversal psoas muscle thickness (TPMT) of<12 mm/m(bodyheight) (men) and<8 mm/m (women) at the level of the third lumbar vertebrae using cross-sectional imaging (CT/MRI). Cirrhotic controls, matched according to equivalent Child-Turcotte-Pugh (CTP) stages, were included.

Results 75 PSVD (age:47.8±16.4years, male:61%, median CTP:6(IQR: 5-7), history of decompensation:48%) and 150 cirrhotic patients (age:57.3±13.9years, male:76%, median CTP:6(IQR: 5-8), history of decompensation:48%) were included. Sarcopenia was present in 31% vs. 32% of patients with PSVD (mean TPMT:12.2±3.7mm/m) and cirrhosis (mean TPMT:12.9±3.2mm/m). Prevalence of sarcopenia in PSVD was especially high in patients with (a history of) malignant diseases (4/10, 40%) and HIV-infection (5/7, 57%), while it was comparable between patients with (n=15/52, 29%) and without (n=8/23, 35%, p=0.607) specific clinical signs of portal hypertension (PH, i.e. presence of varices, porto-systemic collaterals, or history of PH-related bleeding). After adjusting for MELD, higher TPMT trended towards a reduced risk for (further) hepatic decompensation or death (aHR: 0.88(95%CI:0.78-1.00;p=0.056) in patients with PSVD. Overall survival rates were significantly higher in PSVD patients (at 1 year (Y): 93% vs. 87%, at 2Y: 88% vs. 73%;p<0.001). Importantly, survival benefit was not apparent in the subgroup of sarcopenic patients (PSVD vs. cirrhosis: at 1Y: 80% vs. 85%, at 2Y: 73% vs. 73%;p=0.190).

Conclusions Prevalence of sarcopenia is comparable in patients with PSVD and cirrhosis. While sarcopenia was not linked to PH, it may indicate an increased risk of decompensation and mortality in PSVD.

Publication History

Article published online:
26 August 2022