Myosteatosis tied to sarcopenia, poor outcomes in patients with cirrhosis

Patients with cirrhosis have a high prevalence of myosteatosis, either alone or in combination with sarcopenia, which can contribute to the development of worse outcomes, reports a study.

“Our analyses revealed that myosteatosis is the most frequent alteration and has a significant impact on the course of liver disease,” the researchers said.

"The prognostic role of sarcopenia should always be evaluated in relation to the presence of myosteatosis,” they added.

A total of 433 patients were included in this prospective multicentre study. CT scans were used to evaluate sarcopenia and myosteatosis.

The researchers assessed the 1-year cumulative incidence of relevant events via competing risk analysis. They also examined the impact of sarcopenia and myosteatosis on mortality, hospitalization, and liver decompensation using a Fine-Gray model adjusted for known prognostic factors.

Of the participants, 166 presented with isolated myosteatosis, 36 with isolated sarcopenia, 135 with combined sarcopenia and myosteatosis, and 96 had no muscle changes at enrolment. [J Hepatol 2024;81:641-650]

The cumulative incidence of death at 1 year in patients with either isolated myosteatosis or combined sarcopenia and myosteatosis was more than twofold higher than that of those without muscles changes or with isolated sarcopenia (13.4 percent and 13.8 percent vs 5.2 percent and 5.6 percent, respectively).

Death in patients with muscle changes had an adjusted subhazard ratio of 1.36 (95 percent confidence interval [CI], 0.99–1.86; p=0.058).

The cumulative incidence of hospitalization was significantly greater in patients with combined sarcopenia and myosteatosis than in those with no muscle changes (adjusted subhazard ratio, 1.18, 95 percent CI, 1.04–1.35).

Similarly, the cumulative incidence of liver decompensation was higher in patients with combined sarcopenia and myosteatosis (p=0.018) and those with isolated sarcopenia (p=0.046) than among individuals without muscle changes.

Additionally, function tests and frailty scores showed a robust association with the presence of muscle changes.

“Our study suggests that muscle function tests could serve as a valuable and practical bedside tool for estimating prognosis and identifying patients at greater risk of mortality,” the researchers said.

An earlier study examining the combination of reduced muscle function, quality, and quantity in 197 patients found that myosteatosis may precede the onset of other muscle abnormalities. [J Clin Med 2023;12:3332]

Researchers of the current study suggested a possible psychological explanation for the above finding.

“Chronic hyperammonaemia, present in cirrhosis, induces mitochondrial dysfunction and a subsequent reduction in lipid oxidation, leading to intramuscular fat infiltration (myosteatosis),” they said. [J Physiol 2016;594:7341-7360]

Another study also reported the relation of intramuscular fat, which contributes to insulin resistance, to the development of lipotoxic profile associated with the secretion of fatty acids and inflammatory adipokines, which have been shown to have a harmful effect on myocyte function. [Aging Med (Milton) 2019; 2:147-156]

“Our study has shown that a comprehensive and integrated assessment of muscle changes is crucial for understanding their role in the natural history of cirrhosis,” the researchers said.

Many previous studies have focused on the assessment of sarcopenia, but concomitant myosteatosis is likely to play a major prognostic role. This may resize the predictive role of sarcopenia in favour of a more comprehensive consideration of muscle changes.