Determinants of Skeletal Muscle Preservation in Patients with Chronic Liver Disease.

Introduction: Preventing skeletal muscle mass loss may improve survival in patients with chronic liver disease (CLD); however, the clinical factors associated with maintaining skeletal muscle mass remain poorly understood. Methods: Clinically stable patients with CLD who underwent multiple computed tomography scans between March 2004 and April 2023 were enrolled. The annual rate of change in skeletal muscle area (ΔSMA/year) was assessed using a 3-dimensional image analysis system. Muscle mass preservation was defined as ΔSMA/year ≥0. The clinical factors associated with the prevention of muscle mass loss and their association with mortality were assessed using logistic regression analysis and Cox proportional hazards models. Results: Of the 586 patients (52% men; median age, 67 years; median model for end-stage liver disease score, 9), muscle mass was preserved in 124 (21%). Male sex (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27-0.73), alcohol-related liver disease (OR, 0.37; 95% CI, 0.18-0.77), and the branched-chain amino acids-to-tyrosine ratio (BTR) (OR, 1.17; 95% CI, 1.03-1.33) were independently associated with preservation of muscle mass. During a median follow-up of 3.7 years, patients with muscle preservation had a higher overall survival rate than those without (log-rank test, Conclusions: Male sex, alcohol-related liver disease etiology, and BTR are independent factors for muscle mass preservation, which is a significant determinant of survival in patients with CLD.