Sarcopenia Exacerbates Liver-Related Complications in Patients with Cirrhosis and Hepatic Encephalopathy: A Nationwide Analysis Highlighting Inpatient Outcomes and Gender Differences

Document Type

Abstract

Publication Date

Fall 10-1-2024

Abstract

Background: Sarcopenia, characterized by the loss of skeletal muscle mass and strength, is a common clinical manifestation among patients with cirrhosis. Sarcopenia may exacerbate hepatic encephalopathy due to altered pathophysiological mechanisms of ammonia metabolism. This study aimed to investigate the impact of sarcopenia on liver-related complications and outcomes in patients with encephalopathy secondary to cirrhosis using a nationwide inpatient database. Methods: A retrospective analysis was conducted using data from the National Inpatient Sample (NIS) database from 2016 to 2020. Patients with a principal diagnosis of encephalopathy in the setting of liver cirrhosis were identified using ICD-10 codes. The study population was divided into two groups: those with and without sarcopenia. Primary outcomes included inpatient mortality and the prevalence of cirrhosis-related complications. Multivariable regression analyses were performed, adjusting for demographics and confounders. Results: Among 115,335 hepatic encephalopathy hospitalizations, 165 (0.14%) had a diagnosis of sarcopenia. Sarcopenic patients had significantly higher odds of developing spontaneous bacterial peritonitis (OR 2.89, 95% CI 1.05-7.96), portal venous thrombosis (PVT) (OR 3.39, 95% CI 1.28-9.00), ascites (OR 2.92, 95% CI 1.48-5.76), varices with and without bleeding (OR 3.36, 95% CI 1.49-7.54), non-bleeding varices (OR 2.75, 95% CI 1.23-6.18), needing transjugular intrahepatic portosystemic shunt (OR 10.68, 95% CI 2.42-47.00), and have liver failure (OR 4.88, 95% CI 2.27-10.49) compared to non-sarcopenic patients (Table 1). Although sarcopenic patients had lower odds of inpatient mortality (OR 0.15, 95% CI 0.15-0.16), the association was not statistically significant (p = 0.072). Sarcopenic patients also had a longer average length of stay and higher total hospital charges. Moreover, there is a higher proportion of males among patients with sarcopenia (72.7%) compared to those without sarcopenia (59.5%). Conversely, the proportion of females is lower in the sarcopenia group (27.3%) compared to the non-sarcopenia group (40.5%). Conclusion: This nationwide retrospective study revealed that sarcopenia is associated with a significantly higher prevalence of liver-related complications in patients with cirrhosis and hepatic encephalopathy, especially males. These findings underscore the importance of identifying and managing sarcopenia in patients with hepatic encephalopathy to potentially improve outcomes and reduce the risk of complications.

Publication Title

Hepatology

Volume

80

Issue

Supplement 1

First Page

S1714

Last Page

S1715

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