Treatment on the Spleen Prevents the Progression of Secondary Sarcopenia in Patients With Liver Cirrhosis

Abstract

Hyperammonemia is an important stimulator of myostatin expression, a negative regulator of muscle growth. After splenectomy or partial splenic artery embolization (PSE), hyperammonemia often improves. Thus, we investigated changes in skeletal muscle index (SMI) in patients following an operation on the spleen and in patients who did not undergo an operation on their spleen. The study was designed retrospectively, in which we analyzed data collected between January 2000 and December 2015. Patients were assigned to the splenectomy/PSE or nontreatment group. Changes in SMI (Delta SMI), ammonia (Delta ammonia), myostatin (Delta myostatin), irisin (Delta irisin), and branched-chain amino acids/tyrosine molar ratio (Delta BTR) were analyzed between baseline and 5-year follow-up both before and after inverse probability of treatment weighting adjustment (IPTW). Patients (102) were enrolled (splenectomy/PSE, n = 45; nontreatment group, n = 57) before IPTW adjustment: Delta SMI (2.6 cm(2)/m(2) vs. -8.8 cm(2)/m(2), respectively) (P < 0.001), Delta myostatin (-867 vs. -568, respectively) (P < 0.001), Delta ammonia (-34 and 16, respectively) (P < 0.001), and Delta BTR (0.89 and -0.665, respectively) (P < 0.001). There were no differences between splenectomy and PSE regarding these factors. Moreover, after IPTW adjustment, significant differences were observed between the splenectomy/PSE and nontreatment group for the median Delta BTR (0.89 and -0.64, respectively) (P < 0.001), Delta ammonia (-33 and 16, respectively) (P < 0.001), Delta myostatin (-894 and 504, respectively) (P < 0.001), and Delta SMI (1.8 cm(2)/m(2) and -8.2 cm(2)/m(2), respectively) (P < 0.001). Conclusions: Both splenectomy and PSE were associated with the prevention of secondary sarcopenia in patients with LC. Moreover, it can be expected that muscle volume loss is reduced by splenectomy or PSE in patients with hyperammonemia.