Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis

• Published in: Journal of gastroenterology 2020-02, Vol.55 (2), p.217-226
• Main Authors: Namba, Maiko, Hiramatsu, Akira, Aikata, Hiroshi, Kodama, Kenichiro, Uchikawa, Shinsuke, Ohya, Kazuki, Morio, Kei, Fujino, Hatsue, Nakahara, Takashi, Murakami, Eisuke, Yamauchi, Masami, Kawaoka, Tomokazu, Tsuge, Masataka, Imamura, Michio, Chayama, Kazuaki
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aldosterone; Ascites; Biliary Tract; Care and treatment; Cirrhosis; Colorectal Surgery; Computed tomography; Corticosteroids; CT imaging; Diuretics; Edema; Furosemide; Gastroenterology; Hepatology; Liver cirrhosis; Medical imaging; Medical prognosis; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Multivariate analysis; Muscles; Musculoskeletal system; Original Article—Liver; Pancreas; Patient outcomes; Prognosis; Sarcopenia; Skeletal muscle; Surgical Oncology; Survival
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-019-01623-4

Background This study investigated time-course changes in skeletal muscle volume per year with tolvaptan in patients with refractory ascites that was unresponsive to loop diuretics and aldosterone antagonists. Methods This retrospective study included 42 patients who received tolvaptan for refractory ascites and/or hepatic edema and underwent computed tomography (CT) before and ≥ 3 months after initiating tolvaptan. The time-course changes in skeletal muscle index per year [ΔSMI (%)] was calculated as follows: ΔSMI (%) = (SMI at final CT scan − SMI at initial CT scan)/SMI at initial CT scan × 100/years between CT scans. Results Eligible patients were 23 men and 19 women of median age of 71 years (range 21–94 years). The median follow-up period was 22.7 (range 3.5–54.6) months. ΔSMI (%) was significantly higher in the responders group than in the nonresponder group. Multivariate analysis showed the response to tolvaptan was an independent and significant factor associated with an increase in muscle mass [odds ratio (OR) 20.364; 95% CI 2.327–178.97; P  = 0.006]. Overall survival with tolvaptan was significantly higher in the responder group than in the nonresponder group. Multivariate analysis showed that the response to tolvaptan treatment was a significant contributor to good prognosis (OR 3.884; 95% CI 1.264–11.931; P  = 0.018). A significant negative correlation was observed between the dosage of furosemide and ΔSMI (%) ( P  = 0.014). Conclusions Treatment of refractory ascites with tolvaptan may attenuate the progression of sarcopenia and improve the prognosis in patients with decompensated cirrhosis.