Correlation Analysis Of Sarcopenia,Osteoporosis,Vertebral Fragility Fracture,and Liver Fat Content In Patients With Liver Cirrhosis Using QCT

Objective:(1)To investigate the correlation between sarcopenia,osteoporosis,and vertebra fragility fracture using quantitative computed tomography(QCT)in patients with liver cirrhosis,and(2)to clarify whether liver fat fraction measured by QCT is used as an indicator to evaluate liver function in patients with liver cirrhosis.Methods: Patients with liver cirrhosis(n=365)and normal controls(n=130)in our hospital from July2019 to September 2022 were involved in this study.All participants had been undergoing abdominal non-contrast CT scans.The skeletal muscle mass at the third lumbar vertebral plane(SMA-L3),muscle fat infiltration in posterior muscle groups at the third lumbar vertebral plane(MFI-L3),lumbar mineral density(BMD),and liver fat fraction(LFF)were measured using QCT Pro software.The skeletal muscle mass index at the third lumbar vertebral plane(SMI-L3)is SMA-L3/height2.The differences in each QCT parameter between the cirrhotic and control groups were compared.The variables with statistically significant univariate analysis were included in the multifactorial logistic regression analysis to screen the influences of sarcopenia,osteoporosis,vertebral fragility fracture,and moderate to severe hepatic steatosis in patients with liver cirrhosis.The receiver operating characteristic curve(ROC)was plotted to analyze the diagnostic value of LFF for Child-Pugh class C in patients with cirrhosis.Results: SMI-L3 and lumbar BMD in the patients with liver cirrhosis were lower than those in the controls(P<0.05),and MFI-L3,osteoporosis prevalence,vertebral fragility fracture prevalence,and LFF were higher than those in the controls(P<0.05).Age,osteoporosis prevalence,vertebral fragility fracture prevalence,and Child-Pugh class were higher in the sarcopenic group than those in the non-sarcopenic group(P<0.05),and body mass index(BMI)and lumbar BMD were lower than those in the non-sarcopenic group(P<0.001).Women prevalence,age,sarcopenia prevalence,MFI-L3,and vertebral fragility fracture prevalence in the osteoporosis group were higher than those in the non-osteoporosis group(P < 0.05),and the SMI-L3 was lower than those in the non-osteoporosis group(P<0.001).Women prevalence,age,sarcopenia prevalence,MFI-L3,and osteoporosis prevalence were higher in the vertebral fragility fracture group than those in the non-vertebral fragility fracture group(P<0.05),and SMI-L3 and lumbar BMD were lower than those in the non-vertebral fragility fracture group(P<0.05).Men prevalence,BMI,Child-Pugh class,and model for end-stage liver disease(MELD)score were higher in the moderate to severe hepatic steatosis group than those in the group with non-moderate to severe hepatic steatosis(P<0.05),and the age was lower than those in the group of non-moderate to severe hepatic steatosis(P<0.05).The multivariate logistic regression analysis showed that age,osteoporosis,and Child-Pugh C were all independent risk factors for sarcopenia in patients with liver cirrhosis(P<0.05),and BMI was an independent protective factor for sarcopenia in patients with liver cirrhosis(P<0.05).Females,age,sarcopenia,and vertebral fragility fracture were all independent risk factors for osteoporosis in patients with liver cirrhosis(P<0.05).Age and osteoporosis were all independent risk factors for vertebral fragility fracture in patients with liver cirrhosis(P<0.001).BMI,Child-Pugh C,and MELD score were all independent risk factors for moderate to severe hepatic steatosis in patients with liver cirrhosis(P<0.05).The ROC showed that the area under the curve(AUC)of LFF for diagnosing Child-Pugh C in patients with liver cirrhosis was 0.738,the cut-off value was 14.467%,sensitivity was 58.21%,specificity was 82.89%.Conclusions: 1,Patients with liver cirrhosis who have poor liver function are more likely to combine sarcopenia,patients with liver cirrhosis who combine sarcopenia are more likely to develop vertebral fragility fractures;2,Sarcopenia and osteoporosis are mutual risk factors in patients with liver cirrhosis;3,Liver fat content is valuable for evaluating liver function in patients with liver cirrhosis.