Effect of adipose-related parameters on mortality in patients with liver cirrhosis: a meta-analysis

Some adipose-related parameters exhibit distinct prognostic value in patients with cirrhosis. However, the magnitude and direction of the association between individual adipose parameter and mortality in patients with cirrhosis are unclear.
This study aimed to evaluate the association between individual adipose parameter and mortality in patients with cirrhosis using the meta-analysis method.
The PubMed, Embase, Web of Science, China Biological Medicine, WanFang, and China National Knowledge Infrastructure databases were searched from inception through December 15, 2023, to identify eligible studies. The impact of each adipose parameter on mortality was assessed by the pooled unadjusted or adjusted hazard ratio (HR) with 95% confidence intervals (CIs) using the random effects model.
A total of 33 studies involving 9626 patients were included in our analysis, with 11 adipose parameters evaluated. The pooled prevalence of sarcopenic obesity (SO) and myosteatosis in patients with cirrhosis was 15.5% and 34.4%, respectively. In adjusted analysis, each unit increase in subcutaneous adipose tissue index (SATI) (HR: 0.99, 95% CI: 0.98–1.00) or muscle attenuation (MA) (HR: 0.94, 95% CI: 0.90–0.98) and each unit decrease in visceral-to-subcutaneous adipose tissue ratio (VSR) (HR: 1.92, 95% CI: 1.45–2.54) showed an independent association with a decreased risk of mortality. However, concurrent myosteatosis (HR: 1.88, 95% CI: 1.48–2.40) or SO (HR: 2.77, 95% CI: 1.95–3.93) significantly increased the risk of mortality in patients with cirrhosis.
Decreased SATI or MA, increased VSR, and concurrent myosteatosis or SO were independently associated with a higher risk of mortality in patients with cirrhosis.
The associations between various adipose parameters and mortality in patients with cirrhosis remain to be determined. Therefore, we performed the first meta-analysis to determine the effect of adipose parameters on survival in patients with cirrhosis. A total of 33 studies involving 11 adipose parameters were assessed in our analysis. We found that different adipose parameters exhibited varying prognostic value: decreased subcutaneous adipose tissue index or muscle radiodensity, increased visceral-to-subcutaneous ratio, and concurrent myosteatosis or sarcopenic obesity were independently associated with a higher risk of mortality in patients with cirrhosis. Prognostic models based on these adipose parameters will contribute to the individualized management of patients with liver cirrhosis.