Hepatology International

, Volume 12, Issue 4, pp 377–386 | Cite as

Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis

  • Rahima A. Bhanji
  • Carlos Moctezuma-Velazquez
  • Andres Duarte-Rojo
  • Maryam Ebadi
  • Sunita Ghosh
  • Christopher Rose
  • Aldo J. Montano-LozaEmail author
Original Article



Skeletal muscle is known to play a role in hepatic encephalopathy. Fatty infiltration of the muscle (myosteatosis) and muscle mass depletion (sarcopenia) are frequent complications of cirrhosis.


The purposes of the study were to investigate if myosteatosis and sarcopenia are associated with overt hepatic encephalopathy in patients with cirrhosis and to evaluate their impact on mortality.


A total of 675 cirrhotic patients were studied. Computed tomography scans were used to analyze the skeletal muscle. Hepatic encephalopathy was defined by either a hepatic encephalopathy-related hospitalization and/or taking ammonia-lowering treatment (i.e., lactulose, rifaximin).


Myosteatosis was observed in 348 patients (52%), sarcopenia in 242 (36%), and hepatic encephalopathy in 128 (19%) patients. Both myosteatosis (70 vs. 45%, p < 0.001) and sarcopenia (53 vs. 32%, p < 0.001) were more frequent in patients with hepatic encephalopathy. By multivariable regression analysis, both myosteatosis and sarcopenia were associated with a higher risk of hepatic encephalopathy, independent of the MELD score (OR 2.25; 95% CI, 1.32–3.85, p = 0.003 and OR 2.42; 95% CI, 1.43–4.10, p = 0.001, respectively). In univariate Cox proportional hazards analysis, sarcopenia (csHR 2.02; 95% CI, 1.57–2.58, p < 0.001), myosteatosis (csHR 1.45; 95% CI, 1.16–2.91, p = 0.004), and hepatic encephalopathy (csHR 1.61; 95% CI, 1.20–2.18, p = 0.002) were associated with mortality, but only sarcopenia was significant in the multivariable analysis (csHR 2.15; 95% CI, 1.52–3.05, p < 0.001).


Myosteatosis and sarcopenia are independently associated with overt hepatic encephalopathy in patients with cirrhosis. The association between hepatic encephalopathy and mortality may be explained at least partially by the presence of sarcopenia. These results identify the importance of muscle mass and suggest therapeutic strategies to attenuate muscle mass loss and improve muscle quality.


Nutrition Liver transplantation Liver cirrhosis Hepatic encephalopathy 



RAB received a grant from the Canadian Association for the Study of the Liver (CASL) to accomplish her hepatology fellowship. CMV received a grant from Gilead Canada to accomplish his hepatology fellowship. This study has been funded in part by a Clinical Research Award from the American College of Gastroenterology Institute (AML).

Compliance with ethical standards

Conflict of interest

Rahima A. Bhanji, Andres Duarte-Rojo, Carlos Moctezuma-Velazquez, Maryam Ebadi, Sunita Ghosh, Christopher Rose, and Aldo J. Montano-Loza, declare that they have no conflict of interest.

Informed consent in studies with human subjects

The study was approved by the institutional review board prior to data collection. This study is a retrospective analysis, it did not include any human trial, and as such no informed consent from patients was needed. This article does not contain any studies with animal subjects.

Supplementary material

12072_2018_9875_MOESM1_ESM.pptx (50 kb)
Supplementary material 1 Graphic of the Fine and Gray proportional sub-distribution hazards model, including only variables that were significant in the multivariable analysis. (PPTX 49 kb)


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Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  • Rahima A. Bhanji
    • 1
  • Carlos Moctezuma-Velazquez
    • 1
  • Andres Duarte-Rojo
    • 2
  • Maryam Ebadi
    • 1
  • Sunita Ghosh
    • 3
  • Christopher Rose
    • 4
  • Aldo J. Montano-Loza
    • 1
    Email author
  1. 1.Division of Gastroenterology and Liver Unit, University of Alberta HospitalUniversity of AlbertaEdmontonCanada
  2. 2.Division of Gastroenterology and HepatologyUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of OncologyCross Cancer InstituteEdmontonCanada
  4. 4.Department of MedicineUniversité de Montréal CRCHUMMontréalCanada

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