Low skeletal muscle mass predicts early mortality in cirrhotic patients with acute variceal bleeding

Objectives Low skeletal muscle mass adversely affects outcomes in cirrhotic patients; however, its affect in patients with acute variceal bleeding remains unknown. The aim of this study was to evaluate the effects of low skeletal muscle mass on outcomes in patients with cirrhosis and acute variceal bleeding. Methods We evaluated 122 patients to identify factors associated with two outcomes: failure to control bleeding, defined as either rebleeding or death within 5 d, and 6-wk mortality. Skeletal muscle mass was estimated by calculating the psoas muscle area at the third lumbar vertebra on computed tomographic images. Results Forty-two patients had low skeletal muscle mass. Fifteen patients had failure to control bleeding and 32 patients died within 6 wk. Six of the patients with low skeletal muscle mass and nine without low skeletal muscle mass had failure to control bleeding; these proportions did not differ significantly (P = 0.628). Fifteen of the patients (35.7%) with low skeletal muscle mass died within 6 wk; this proportion was marginally higher than the 17 (21.3%) without low skeletal muscle mass who died within 6 wk (P = 0.084). On multivariate analysis, presence of low skeletal muscle mass (odds ratio [OR], 4.69; P = 0.024), nonalcoholic etiology (OR, 10.3; P = 0.024), higher international normalized ratio of prothrombin time (OR, 41.4; P < 0.001), and rebleeding within 6 wk (OR, 27; P < 0.001) were associated with 6-wk mortality. Conclusions Low skeletal muscle mass is an independent predictor of 6-wk mortality in cirrhotic patients with acute variceal bleeding.