Impact of sarcopenia on variceal rebleeding in patients after endoscopic therapy: a multicenter retrospective cohort study based on propensity score matching

Figures & data

Figure 1. Flowchart. Retrospective selection process of patients.

Table 1. Clinicopathologic characteristics of 336 patients with liver cirrhosis.

Variable	All patients (n = 336)
Age (years)	55 ± 10.49
Male, n (%)	208(61.9%)
BMI (kg/m^2)	23.39 ± 3.24
Etiology, n (%)
Hepatitis B	168(50%)
Hepatitis C	15(4.5%)
Alcohol	33(9.8%)
Autoimmune	31(9.2%)
Others	85(26.5%)
Laboratory finding
Hemoglobin (g/L)	90.19 ± 21.47
Platelet count (10^9/L)	104.62 ± 80.22
Total bilirubin (μmol/L)	18.31 ± 10.83
ALT (U/L)	27.61 ± 26.54
AST (U/L)	32.71 ± 20.18
Serum albumin (g/L)	36.25 ± 4.63
PT (s)	14.47 ± 2.05
INR	1.28 ± 0.19
Child-Pugh score	6.41 ± 1.44
Child-Pugh A, n (%)	194(57.7%)
MELD score	9.82 ± 2.29
Endoscopic features (F1/F2/F3)	0/23/313
Prevalence of PVT, n (%)	132(39.3%)
Ascites, n (%)	150(44.6%)
Number of endoscopic treatments	2.15 ± 0.884
Number of bands	9.4 ± 3.165
NSBBs used, n (%)	248(73.8%)
sarcopenia, n (%)	109(32.4%)

Data are means ± standard deviations.

BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PT, prothrombin time; INR, international normalised ratio; MELD, Model For End Stage Liver Disease; PVT, portal vein thrombosis; NSBBs, nonselective beta-receptor blockers.

Table 2. Clinical and endoscopic features of cirrhotic patients with and without sarcopenia before and after propensity score matching.

Variables	Before PSM			After PSM
	Sarcopenia (n = 109)	Without sarcopenia (n = 227)	p value	Sarcopenia (n = 72)	Without sarcopenia (n = 72)	p value
Age (years)	56.77 ± 10.42	54.16 ± 10.44	0.033	54.28 ± 10.22	54.56 ± 10.64	0.873
Male, n (%)	76(69.7%)	132(58.1%)	0.041	47(65.3%)	43(59.7%)	0.491
BMI (Kg/m^2)	21.78 ± 2.77	24.17 ± 3.16	<0.001	22.53 ± 2.74	22.14 ± 2.77	0.4
Etiology, (n%)			0.151			0.212
Hepatitis B	49(45%)	119(52.4%)		33(45.8%)	37(51.4%)
Hepatitis C	6(5.5%)	9(4%)		2(2.8%)	5(6.9%)
Alcoholic	12(11%)	21(9.3%)		7(9.7%)	11(15.3%)
Autoimmune	16(14.7%)	15(6.6%)		10(13.9%)	4(5.6%)
Others	26(23.9%)	63(27.8%)		20(27.8%)	15(20.8%)
Hemoglobin (g/L)	86.86 ± 19.86	91.78 ± 22.07	0.049	86.82 ± 20.17	86.90 ± 18.89	0.980
Platelet count (10^9/L)	95.22 ± 69.75	109.14 ± 84.56	0.112	102.44 ± 80.12	105.36 ± 79.04	0.826
ALT (U/L)	25.6 ± 22.25	28.57 ± 28.36	0.337	27.32 ± 24.51	25.38 ± 20.29	0.605
AST (U/L)	33.23 ± 23.62	32.45 ± 18.36	0.763	32.9 ± 20.89	32.31 ± 18.26	0.855
Total bilirubin (μmol/L)	19.73 ± 11.92	17.63 ± 10.23	0.096	18.97 ± 10.55	18.51 ± 11.27	0.803
Serum albumin (g/L)	35.24 ± 4.62	36.73 ± 4.57	0.005	35.57 ± 4.93	35.93 ± 4.83	0.660
PT(s)	14.71 ± 2.08	14.35 ± 2.04	0.133	14.61 ± 1.99	14.75 ± 2.03	0.668
INR	1.3 ± 0.18	1.27 ± 0.19	0.166	1.29 ± 0.17	1.31 ± 0.19	0.515
Child-Pugh class, n (%)			<0.001			0.898
A	48(44%)	146(64.3%)		36(50%)	36(50%)
B	57(52.3%)	75(33%)		34(47.2%)	33(45.8%)
C	4(3.7%)	6(2.6%)		2(2.8%)	3(4.2%)
Child-Pugh score	6.81 ± 1.42	6.22 ± 1.41	<0.001	6.67 ± 1.42	6.61 ± 1.56	0.824
MELD score	10.1 ± 2.15	9.69 ± 2.35	0.124	9.96 ± 2.04	10.06 ± 2.34	0.789
Endoscopic features, n (%)			0.831			0.479
F2	10(9.2%)	14(6.2%)		9(12.5%)	12(16.7%)
F3	99(90.8%)	213(93.8%)		63(87.5%)	60(83.3%)
Number of endoscopic treatments	2.12 ± 0.87	2.17 ± 0.89	0.611	2.15 ± 0.93	1.99 ± 0.88	0.271
Number of bands	9.07 ± 3.34	9.56 ± 3.07	0.202	9.32 ± 3.41	9.65 ± 2.95	0.531
Ascites, n (%)	59(54.1%)	91(40.1%)	0.015	36(50%)	36(50%)	1
PVT, n (%)	48(44%)	84(37%)	0.217	26(36.1%)	32(44.4%)	0.308
NSBBs used, n (%)	84(77.1%)	164(72.2%)	0.347	57(79.2%)	54(75%)	0.552

Data are means ± standard deviations.

BMI, body mass index; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PT, prothrombin time; INR, international normalised ratio; MELD, Model For End Stage Liver Disease; PVT, portal vein thrombosis; NSBBs, nonselective beta-receptor blockers.

Figure 2. (A) Kaplan–Meier curves of variceal rebleeding 2-year post-operative rebleeding before matching; (B) Kaplan–Meier curves of variceal rebleeding 2-year post-operative rebleeding after matching.

Table 3. Competing risk factor of 2-year rebleeding in all patients.

Variables	Univariate analysis HR (95%CI)	p value	Multivariate analysis HR (95%CI)	p value
Albumin	0.928(0.883–0.975)	0.003
ALT	1.007(1.0–1.014)	0.055
Total bilirubin	1.016(0.998–1.034)	0.08
Hemoglobin	0.983(0.972–0.994)	0.003	0.987(0.976–0.999)	0.028
PT	1.155(1.041–1.281)	0.006
INR	4.9(1.548–15.512)	0.007
Child-Pugh score	1.299(1.139–1.482)	<0.001	1.175(1.014–1.361)	0.032
MELD score	1.13(1.033–1.237)	0.008
Ascites	1.893(1.217–2.943)	0.005
sarcopenia	3.134(1.886–5.209)	<0.001	2.754(1.759–4.313)	<0.001
PVT	1.079(0.693–1.681)	0.737
NSBBs used	0.579(0.367–0.912)	0.018	0.578(0.366–0.913)	0.019

CI, confidence interval; HR, hazard ratio; ALT, alanine aminotransferase; PT, prothrombin time; INR, international normalised ratio; MELD, Model For End Stage Liver Disease; PVT, portal vein thrombosis; NSBBs, nonselective beta-receptor blockers.

Table 4. Competing risk factor of 2-year rebleeding in matched patients.

Variables	Univariate analysis HR (95%CI)	P value	Multivariate analysis HR (95%CI)	P value
Albumin	0.936(0.877–0.999)	0.048
Total bilirubin	1.008(0.981–1.037)	0.559
Hemoglobin	0.986(0.971–1.002)	0.082
Child-Pugh score	1.234(1.029–1.480)	0.023	1.254(1.042–1.510)	0.017
MELD score	1.046(0.911–1.20)	0.524
Ascites	1.749(0.949–3.225)	0.073
NSBBs used	0.520(0.275–0.985)	0.045
sarcopenia	3.134(1.886–5.209)	<0.001	3.490(1.756–6.938)	<0.001

CI, confidence interval; HR, hazard ratio; MELD, Model For End Stage Liver Disease; NSBBs, nonselective beta-receptor blockers.

Data availability statement

The authors will supply the relevant data in response to reasonable requests.