Author information

¹Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH 44195; Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

²Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

³Department of Quantitative Health Sciences, Cleveland Clinic Foundation, 9500 Euclid Avenue, NB21, Cleveland, OH 44195.

⁴Digestive Diseases and Surgery Institute, Section of Hepatology, Cleveland Clinic Foundation, 2049 East 100 Street/ A-51, Cleveland, OH 44195.

⁵Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. Electronic address: GADANIS@ccf.org.

Abstract

Purpose: To investigate effects of baseline and early longitudinal body composition changes on mortality and HE after TIPS METHODS: Case-control study with analysis of a TIPS registry (1995-2020) including data from cirrhotic patients with CT scans obtained within 1 month prior to and 3 months after TIPS. Core muscle area (CMA), macroscopic subcutaneous and visceral adipose tissue (mSAT, mVAT) area, and muscle adiposity index (MAI) on CT were obtained. Multipredictor Cox proportional hazards models used to assess the effect of body composition variables on mortality or HE.

Results: Total 280 patients (158 men; median 57.0 years; median MELD-Na score, 14.0) were included. 34 patients had post-TIPS imaging. Median baseline CMA was 68.3 [interquartile range (IQR): 57.7, 83.5] cm2. Patients with higher baseline CMA had decreased risks of mortality (hazard ration (HR): 0.82; P = .04) and HE (HR: 0.82; P = .009). It improved prediction of mortality over MELD-Na and post-TIPS right atrial pressure alone (CI = 0.729). An increase in CMA (HR: 0.60; P = .043) and mSAT (HR: 0.86; P = .022) or decrease in MAI (HR: 1.50; P = .049) from before to after TIPS was associated with a decreased risk of death. An increase in mSAT was associated with an increased risk of HE (HR: 1.11; P = .04).

Conclusion: CMA on CT scan one month prior to TIPS placement predicts mortality and HE in cirrhotic patients. Changes in body composition on CT measured 3 months after TIPS placement independently predicts mortality and HE.