Alcohol-associated liver disease increases the risk of muscle loss and mortality in patients with cirrhosis

BackgroundRapid skeletal muscle loss adversely affects the clinical outcomes of liver cirrhosis. However, the relationships between the annual changes in skeletal muscle area (Delta SMA/year) and the etiology of cirrhosis, factors associated with muscle loss, and risk of mortality remains unclear.MethodsA total of 384 patients who underwent multiple computed tomography (CT) scans between March 2004 and June 2021 were enrolled in this study (median age, 67 years; 64% men; median model for end-stage liver disease score, 9). Body composition and Delta SMA/year were estimated using a 3D image analysis system and data from at least two distinct CT scans. Differences in Delta SMA/year among different etiologies of cirrhosis, factors associated with rapid muscle loss (defined as Delta SMA/year <= - 3.1%), and the association between Delta SMA/year and mortality were examined.ResultsPatients with alcohol-associated liver disease (ALD) cirrhosis experienced more rapid muscle loss (Delta SMA/year, - 5.7%) than those with hepatitis B (Delta SMA/year, - 2.8%) and hepatitis C cirrhosis (Delta SMA/year, - 3.1%). ALD cirrhosis was independently associated with Delta SMA/year <= - 3.1% after adjusting for age, sex, and liver functional reserve. Over a median follow-up period of 3.8 years, ALD cirrhosis, Delta SMA/year <= - 3.1%, and low subcutaneous adipose tissue level were found to be significantly associated with reduced survival. ALD cirrhosis (hazard ratio [HR], 2.43; 95% confidence interval [CI] 1.12-5.28) and Delta SMA/year <= - 3.1% (HR, 3.68; 95% CI 2.46-5.52) were also predictive of mortality.ConclusionsThese results suggest that ALD cirrhosis increases the risk of rapid muscle loss and mortality in affected patients.