2623. Sarcopenia and Associated Imaging Biomarkers in Patients Undergoing Transjugular Intraheaptic Portosystemic Shunt Placement
Authors * Denotes Presenting Author
  1. Marinelda Perlleshi; University of North Carolina School of Medicine
  2. Vedang Patel; University of North Carolina School of Medicine
  3. Hyeon Yu; University of North Carolina School of Medicine
  4. Clayton Commander *; University of North Carolina School of Medicine
For patients with decompensated cirrhosis, treatment of portal hypertension related complications such as variceal bleeding, refractory ascites, and hepatic hydrothorax often involve image-guided intervention, most commonly, transjugular intrahepatic portosystemic shunt (TIPS) placement and transvenous obliteration of varices. Sarcopenia is defined as the progressive loss of muscle mass and strength. Muscle loss is often induced by a systemic inflammatory response leading to decreased appetite, increased catabolism and immobility. In patients with decompensated cirrhosis, particularly those with diuretic-refractory ascites, sarcopenia is a major clinical concern and is often a barrier to transplant.

Materials and Methods:
A retrospective review was conductedof all patients who underwent TIPS at a single academic medical center between 2010 and 2022. Patients were organized into two groups based on the indication for TIPS (refractory ascites/hydrothorax and variceal hemorrhage). Segmentation of the paraspinous muscles was performed on CT scans, allowing for skeletal muscle index (SMI) and skeletal muscle density (SMD) to be determined. These measures were compared between the groups.

Sixty-six patients met inclusion criteria with an average interval between CT and TIPS of 1 month, ranging from 1 day to 3 months. Sarcopenia was defined as an SMI < 10.4 (cm2/m2). The incidence of sarcopenia was significantly higher in patients who underwent TIPS for ascites or hepatic hydrothorax than those with variceal bleeding (p < 0.001). In patients with sarcopenia, SMD in venous phase imaging was significantly higher relative to those without sarcopenia (p < 0.01). There was no difference in MELD score or mortality between the two groups (p = 0.58) or between patients with and without sarcopenia (p = 0.22).

The increased incidence of sarcopenia in patients with ascites and hepatic hydrothorax was consistent with significant protein wasting in comparison to those with variceal bleeding. It is unclear why SMD was higher in patients with sarcopenia. We theorize this finding may reflect underlying systemic inflammation which is known to be present in cirrhotic patients with ascites. Further retrospective and prospective validation are warranted as incorporation of sarcopenia as a predictive factor may reduce associated morbidity and healthcare cost associated with decompensated cirrhosis and further support early TIPS placement in patients with ascites.