Prognostic Value of Psoas Muscle Index Improvement in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt.

PURPOSE: To evaluate the prognostic value of early psoas muscle index (PMI) improvement after transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis and sarcopenia. MATERIALS AND METHODS: This multicenter retrospective study included 390 patients with cirrhosis and sarcopenia who underwent TIPS at five tertiary centers between February 2016 and April 2023. PMI was measured on computed tomography (CT) before TIPS and approximately 1 month afterward. Sarcopenia reversal was defined as a post-TIPS PMI above the sex-specific cutoff values (>6.36 cm2/m2 for men and >3.92 cm2/m2 for women).Associations of PMI improvement with overall survival and overt hepatic encephalopathy (OHE) were evaluated using Kaplan-Meier and Cox regression analyses. Receiver operating characteristic analysis identified optimal cutoff values. RESULTS: At 1 month after TIPS, 188 patients (48.2%) achieved sarcopenia reversal. Sarcopenia reversal was associated with higher cumulative survival (84.6% vs 68.2%; hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.14-0.41; P < .001) and lower OHE incidence (16.6% vs 51.1%; HR, 0.26; 95% CI, 0.17-0.39; P < .001). The PMI improvement rate was an independent predictor of mortality and OHE. Optimal cutoff values were 11.8% for mortality and 15.8% for OHE. Patients with PMI improvement above these thresholds had significantly better survival and lower OHE incidence (both P < .001). CONCLUSIONS: PMI improvement assessed at 1 month after TIPS is independently associated with reduced mortality and OHE in patients with cirrhosis and sarcopenia. PMI assessment 1 month after TIPS may provide a simple imaging biomarker for early prognostic evaluation and risk stratification.