Determinants of Skeletal Muscle Preservation in Patients with Chronic Liver Disease

Preventing skeletal muscle mass loss may improve survival in patients with chronic liver disease (CLD); however, the clinical factors associated with maintaining skeletal muscle mass remain poorly understood.

Clinically stable patients with CLD who underwent multiple computed tomography scans between March 2004 and April 2023 were enrolled. The annual rate of change in skeletal muscle area (ΔSMA/year) was assessed using a 3-dimensional image analysis system. Muscle mass preservation was defined as ΔSMA/year ≥0. The clinical factors associated with the prevention of muscle mass loss and their association with mortality were assessed using logistic regression analysis and Cox proportional hazards models.

Of the 586 patients (52% men; median age, 67 years; median model for end-stage liver disease score, 9), muscle mass was preserved in 124 (21%). Male sex (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27-0.73), alcohol-related liver disease (OR, 0.37; 95% CI, 0.18-0.77), and the branched-chain amino acids-to-tyrosine ratio (BTR) (OR, 1.17; 95% CI, 1.03-1.33) were independently associated with preservation of muscle mass. During a median follow-up of 3.7 years, patients with muscle preservation had a higher overall survival rate than those without (log-rank test, P = 0.007), with a hazard ratio (HR) of 0.58 (95% CI, 0.39-0.87). Preservation of muscle mass also independently predicted improved survival (HR, 0.56; 95% CI, 0.32-0.99).

Male sex, alcohol-related liver disease etiology, and BTR are independent factors for muscle mass preservation, which is a significant determinant of survival in patients with CLD.