Dr. The First Affiliated Hospital, Zhejiang University School of Medicine, China (People's Republic)
Purpose: The present study aims to assess the extent of sarcopenia improvement after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis using psoas muscle index (PMI), and to investigate the relationship between the degree of PMI improvement and clinical outcomes, specifically all-cause mortality and the development of overt hepatic encephalopathy (OHE).
Materials and Methods: In this retrospective study, we included 390 patients with cirrhosis and sarcopenia who underwent TIPS at five medical centers across China. By evaluating changes in the PMI one month after TIPS placement, we systematically analyzed the association between the degree of PMI improvement and clinical outcomes, including overall survival and the risk of OHE.
Results: Of the included patients, 188 (48.2%) experienced reversal of sarcopenia, while 202 (51.8%) did not. The cumulative survival rate was significantly higher in the sarcopenia-reversal group compared with the non-reversal group (84.6% vs. 68.2%, log-rank P < 0.001, HR = 0.24; 95% CI: 0.14-0.41), while the cumulative incidence of OHE was markedly lower (16.6% vs. 51.1%, log rank P < 0.001, HR = 0.26; 95% CI: 0.17-0.39). Univariate and multivariate Cox regression analyses identified the PMI improvement rate as an independent predictor of both overall mortality and OHE occurrence. When stratified by the PMI improvement rate, patients with an improvement >11.8% (n = 248) had significantly better cumulative survival than those with improvement ≤11.8% (89.2% vs. 50.4%, log-rank P < 0.001, HR = 0.07; 95% CI: 0.04-0.12). Similarly, patients with a PMI improvement >15.8% (n = 197) showed a significantly lower incidence of OHE than those with improvement ≤15.8% (5.1% vs. 66.3%, log rank P < 0.001, HR = 0.05; 95% CI: 0.03-0.10).
Conclusion: This study demonstrates that improvement in sarcopenia following TIPS significantly reduces both all-cause mortality and the incidence of OHE in patients with cirrhosis. The PMI improvement rate at 1 month post-TIPS may serve as a sensitive prognostic indicator, offering valuable clinical guidance for optimizing post-TIPS management and improving patient outcomes.
