Longitudinal changes in bone mineral density are associated with long-term survival in patients with cirrhosis: A proof of concept study

Abstract

Abstract Background The impact of longitudinal changes in different body components measured via body composition analysis(BCA) on liver related outcomes in patients with cirrhosis is poorly understood. We evaluated the prognostic relevance these changes in body composition over 1 year in patients with cirrhosis with regard to their long-term outcomes. Methods This was a follow-up study of a randomised controlled trial evaluating changes in bone density measured via dual energy X-ray absorptiometry(DEXA) upon vitamin-D supplementation. Patients with available anthropometric indices, fat mass(FM), fat-free mass(FFM), bone-density at lumbar spine(LD) and left femur-neck(FD)(assessed by T-score) at two time points 1 year apart were assessed for outcomes. The prognostic relevance of change in parameters like ΔFM, ΔFFM, ΔLD and ΔFD over 1 year was assessed and compared with baseline model for end stage liver disease(MELD) score. Results Patients with cirrhosis(n = 112) (mean age-41.8 ± 12 years, 58.5% males) were followed up for median duration of 5.7 years(IQR:3.5–5.7), with 5-year survival rate of 77%. On serial BCA, ΔLD(p = 0.029) and ΔFD(p = 0.003) emerged as significant predictors of survival whereas ΔFM(p = 0.479), ΔFFM(p = 0.245) and ΔBMI (p = 0.949) were not. The area under curve of ΔLD and MELD score for predicting survival was 0.636(0.5-0.773) and 0.664(0.555–0.773), respectively. ΔFD < 0.1 over 1 year had sensitivity and specificity of 70.4% and 56.5% to predict poor survival. Combination of ΔFD, MELD and ascites predicted 5-yr survival with an optimism-corrected c-statistic of 0.785. Conclusion Among body composition parameters, changes in bone mineral density correlate best with long-term survival with prognostic relevance similar to that of ascites and MELD score.