Table 1.
Summary of studies investigating clinical significance of myosteatosis in cirrhosis.
| Author/ Year |
Study Population |
Cutoff for Myosteatosis |
Prevalence of Myosteatosis |
Outcome Associated with Myosteatosis |
|---|---|---|---|---|
| Montano-Loza et al., 2016 [19] | 678 patients with cirrhosis evaluated for LT | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
52% | Myosteatosis was an independent predictor of long-term mortality. |
| Bhanji et al., 2018 [16] | 675 patients with cirrhosis evaluated for LT | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
52% | Myosteatosis was identified in 70% of patients with overt hepatic encephalopathy and was an independent predictor of both hepatic encephalopathy and mortality. |
| Kalafateli et al., 2018 [21] | 98 consecutive patients with cirrhosis | Average psoas muscle radiodensity at the level of the fourth to fifth lumbar vertebrae below 43.14 HU |
20% | Myosteatosis was associated with a higher risk of 12-month mortality after adjusting for age, sex and Child–Pugh score. |
| Tachi et al., 2018 [15] | 362 patients with chronic liver disease | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
82% | Myosteatosis, low BMI, low alanine aminotransferase and female sex were predictors of sarcopenia in patients with chronic liver disease. |
| Nardelli et al., 2019 [28] | 64 patients with cirrhosis who were administered a test to detectminimal hepatic encephalopathy | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
38% | Myosteatosis was associated with the presence of minimal hepatic encephalopathy and the development of overt hepatic encephalopathy. |
| Lattanzi et al., 2019 [31] | 249 patients with cirrhosis evaluated for LT | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
54% | MELD–Sarco–Myo–HE score was developed, which improved MELD accuracy in predicting 3- and 6-month mortality. |
| Czigany et al., 2020 [32] | 225 consecutive recipients of orthotopic LT | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
44% | Higher mortality and complication rates over the first 3 months, length of intensive care unit and hospital stay and procedural costs in patients with myosteatosis, with no differences in long-term graft and patient survival between groups. |
| Shenvi et al., 2020 [27] | 180 recipients of LT | Preoperative fat fraction of MRI <0.8 | 16% | Myosteatosis was associated with increased length of hospital stay post-LT. |
| Meister et al., 2021 [22] | 264 consecutive recipients who underwent deceased donor orthotopic LT | L3 muscle radiodensity <26.6 HU in female and <28.6 HU in male patients | 25% | Applied cutoffs identified patients at risk for inferior short- but not long-term graft and patient outcomes after LT. |
| Bot et al., 2021 [25] | 261 patients listed for LT | Lowest quartile of muscle radiodensity at the level of L3 (<34.0 HU) | 25% | Higher risk of waitlist mortality in patients with myosteatosis (HR of 9.12 (HR 8.88, 95% CI: 1.95–40.41, p = 0.005). No association between intramuscular adipose tissue content and wait-list mortality in multivariate sensitivity analysis. |
| Feng et al., 2021 [24] | 202 hospitalized patients with cirrhosis | L3 radiodensity of the multifidus muscles normalized to the radiodensity of subcutaneous adipose tissue (>−0.44 in male and >−0.37 in female patients) |
19% | Higher incidence of myosteatosis in frail male patient (62.5 vs. 15.8%, p = 0.001). |
| Irwin et al., 2021 [34] | 106 LT recipients | L3 muscle radiodensity <41 HU in patients with a BMI up to 24.9 and <33 in those with a BMI ≥25 kg/m2 |
72% | Myosteatosis was associated with a higher risk of post-LT adverse outcomes, including mortality and allograft failure at 1 year, as well as longer hospital and intensive care unit stays. |
Abbreviations: BMI, body mass index; HU, Hounsfield unit; L3, third lumbar vertebra; LT, liver transplantation.