| Background and Purpose: Malnutrition often occurs in patients with cirrhosis,mainly with sarcopenia and adipose tissue redistribution,and is associated with complications such as hepatic encephalopathy(HE).Although there is no universal diagnostic criteria for malnutrition,the current consensus is to assess and timely intervene in nutrition-risk groups.In recent years,imaging technology has played an increasingly important role in nutritional assessment.Based on CT imaging indexes,including skeletal muscle index(L3-SMI),visceral fat index(VATI)and visceral and subcutaneous adipose tissue area ratio(VSR),this study evaluated the occurrence and influencing factors of liver cirrhosis malnutrition,and its impact on the occurrence and prognosis of complications such as SBP and EVB.Methods: All hospitalized patients with cirrhosis who met the exclusion criteria were strictly screened from March 1,2019 to February 28,2021 in the First Hospital of Lanzhou University,and short-term observation and follow-up of the enrolled patients were carried out for 30 days,and their complications such as SBP,EVB,HE were recorded,and the demographic characteristics,serological data,body mass index(BMI),imaging data,etc.of the included population were collected.The t-test was used for the comparison between the two groups that conformed to the normal distribution,and the Mann-Whitney U test was used for the comparison between the groups that did not conform to the normal distribution.The between-group comparisons were performed using one-way ANOVA,the Kruskal-Wallis H test,and the Bonferroni test.Logistic regression analysis and receiver work characteristic(ROC)curve evaluation index were performed on the factors affecting the occurrence of SBP and EVB in the short term,and the ability to predict complications was carried out.Results:1.A total of 311 patients with cirrhosis were included in the study,and the incidence of sarcopenia was 11.58%(36/311).The age of patients was negatively correlated with L3-SMI(r=0.358,P<0.001),and BMI was positively correlated with L3-SMI(r=0.517,P<0.001).Patients with a Child-Pugh grade of C had a significantly lower L3-SMI than grade A and B.2.The prevalence of sarcopenia increased with increasing Child-Pugh grade(P<0.001).Age,white blood cell(WBC),male sex,hemoglobin(Hb),albumin(ALB),and BMI were independent factors in the development of sarcopenia(P<0.05).3.The incidence of SBP in patients with cirrhosis within 30 days was 17.36%(54/311),of which the incidence of SBP within 30 days in the sarcopenia group was33.33%(12/36)higher than that in the no sarcopenia group 15.27%(42/275)(P<0.05).Sarcopenia was an independent influencing factor of SBP within 30 days(OR=0.921,P=0.001),and the area under the ROC curve was 0.618(P=0.033).4.237 healthy controls were included in the study.The BMI of the cirrhosis group was less than that of the healthy control group(P<0.05),and the VATI and SATI of the cirrhosis group were smaller than those of the healthy control group(27.92 vs.38.60,17.92 vs.122.00,P<0.001),while the VSR of the cirrhosis group was greater than that of the healthy control group(1.37 vs.0.81,P<0.001).VSR and VATI were positively correlated with age in healthy people(r=0.324,P<0.001;r=0.284,P<0.001).VATI,SATI and VSR were positively correlated with BMI(r=0.683,P<0.001;r=0.464,P<0.001;r=0.382,P<0.001).VATI and VSR were higher in men,and SATI was higher in women(P<0.05).Among people with cirrhosis,VATI and SATI were positively correlated with BMI(r=0.627,P<0.001;r=0.564,P<0.001).VATI and VSR were higher in women(P<0.001).The VSR of Child-Pugh grade C was significantly higher than that of grade A and grade B(1.75 vs.1.37,1.25,P<0.05).5.The incidence of EVB within 30 days in patients with cirrhosis was 9.65%(30/311),among which Hb,ALB and SATI in the group without EVB were significantly higher than those in the group with EVB(P<0.05),and VATI in the group without EVB was significantly lower than in the group with EVB(P<0.05).VATI was an independent risk factor for short-term EVB in patients with cirrhosis(OR=0.929,P=0.016),and the area under the ROC curve was 0.724(P<0.001).Conclusion: The patients with poor liver function have a higher prevalence of sarcopenia,which is an independent influencing factor for short-term SBP,and age,sex and BMI are possible influencing factors for sarcopenia.The proportion of visceral fat in healthy people is related to age and sex,while the fat distribution and area changes in people with cirrhosis are independent of age.The higher the proportion of visceral fat in patients with cirrhosis with poor liver function,VATI is an independent risk factor for short-term EVB in patients with cirrhosis. |
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