New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact

TL;DR

This study introduces a new CT-based index, L3-SMHDR, to detect frailty in cirrhosis patients and shows it has strong prognostic value.

Contribution

A novel scanographic index, L3-SMHDR, is proposed for identifying frailty in cirrhosis with high accuracy and prognostic relevance.

Findings

L3-SMHDR is significantly higher in frail patients and those with advanced cirrhosis (Child B/C).

The index shows high sensitivity and specificity for detecting frailty, with strong agreement with clinical assessments.

High L3-SMHDR is associated with lower survival and higher liver-related events in cirrhosis patients.

Abstract

Frailty is linked to an increased incidence of hepatic decompensation and mortality in cirrhosis. The aim of our study was to identify a novel scanographic score that predicts frailty and its impact in cirrhosis.

This study included 51 patients with cirrhosis. We used the frailty scale risk assessment score to identify frail patients. The density and area of different muscles at L3 level were analyzed on computed tomography (CT) sections. The L3 skeletal muscle area adjusted to height and density ratio (L3-SMDHR) was defined as L3 muscle wall*height/density.

The L3-SMHDR is significantly higher in frail patients and in patients with Child B/C scores. Frailty was correlated with L3-SMHDR. Frailty and L3- SMHDR were correlated with liver-related events (LRE). We set the most appropriate cut-offs of L3-SMHDR for both sensitivity and specificity by using the ROC: 5.4 for males and 4.7 for females. The AUROC score was 0.784 for male and 0.975 for female patients. The Kappa score between frailty and L3-SMHDR was 0.752, with a percentage of agreement of 87.5%, showing a substantial agreement. This ratio with the divided categories has a sensitivity of 100%, a specificity of 76%, a positive predictive value of 79.3% and a negative predictive value of 100%. Patients with high L3-SMHDR have significantly lower survival time and a higher incidence of LRE.

The L3-SMHDR is a new index for identifying frailty in cirrhosis by using measurable and reproducible variables. It can be used as a prognostic factor for frailty in patients with cirrhosis.

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