113 CIRRHOTIC CARDIOMYOPATHY MANIFESTED BY LEFT VENTRICLE DIASTOLIC DYSFUNCTION IS A RISK FACTOR IN THE DEVELOPMENT OF HEPATORENAL SYNDROME AND LOWER SURVIVAL

syndrome may be present in chronic liver diseases. We aimed to establish the frequency of sarcopenia in a cohort of patients with cirrhosis being evaluated for liver transplant, to evaluate if sarcopenia is predictive of mortality, and to estimate the correlation of sarcopenia with conventional prognostic scores for patients with cirrhosis. Patients and Methods: 111 patients with cirrhosis who were consecutively evaluated for liver transplant and had a computed tomography (CT) at the 3 lumbar vertebrae were selected. Data were recovered from the medical charts, skeletal muscle crosssectional area was measured by CT, and sarcopenia was defined using previously published sex-specific cutoffs. Results: 77 patients were males (69%) and the mean age was 54±1 years. Mean time of follow-up was 20±2 months. Etiology of liver cirrhosis was HCV (45%), alcohol (23%), autoimmune liver disease (18%), and others (14%). Sarcopenia was present in 44 patients (40%). By univariate Cox analysis the presence of ascites (HR 2.24; P = 0.04), encephalopathy (HR 2.05, P = 0.04), bilirubin (HR 1.01; P < 0.001), INR (HR 5.7; P < 0.001), creatinine (HR 1.01, P = 0.004), albumin (HR 0.94, P = 0.01), MELD (HR 1.11; P< 0.001), Child–Pugh (HR 2.85; P < 0.001), and sarcopenia (HR 2.20; P = 0.005) were associated with mortality. By multivariate Cox regression analysis the MELD score (HR 1.06, P = 0.02), Child–Pugh (HR 2.21; P = 0.03), and sarcopenia (HR 2.13, P = 0.02) were independently associated with early mortality. Median survival for sarcopenic patients was 19±6.1 months, compared to 51.3±16.7 months in non-sarcopenic patients (P = 0.004). There was a poor correlation between sarcopenia and MELD score (r 0.03, P = 0.8) and sarcopenia and Child–Pugh score (r 0.03, P = 0.8). Conclusions: Sarcopenia is a strong and independent predictor of mortality in cirrhosis. Sarcopenia does not correlate with degree of liver dysfunction evaluated with conventional scores (Child– Pugh and MELD). Further studies that include sarcopenia with conventional scores may allow significantly better prediction of mortality among patients waiting for liver transplantation.