P1184 - Muscular Ultrasonography of the Rectus Femoris Muscle to Evaluate for Sarcopenia is Correlated With PELD/MELD Score in Children

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Christopher Chu, MD (he/him/his)

Children's Hospital, CA

Award: Presidential Poster Award

Christopher Chu, MD¹, Patricia Acharya, MD¹, David Rigual, MD¹, Jennifer L. Dodge, MPH², Norah Terrault, MD, MPH³
¹Children's Hospital, Los Angeles, CA; ²University of Southern California, Los Angeles, CA; ³Keck School of Medicine of USC, Los Angeles, CA

Introduction: Inadequate identification of growth failure is a shortcoming of the pediatric end-stage liver disease (PELD) score and may lead to underestimation of waitlist mortality. Sarcopenia is a predictor of waitlist mortality in adults but is understudied in pediatrics. This pilot study seeks to characterize muscle quality and quantity using ultrasound (US) in pediatric patients and correlation these measures to anthropometrics and PELD/MELD(Model for End-Stage Liver Disease) score.

Methods: Patients aged 2-months to 18 years with chronic liver disease (CLD) and healthy controls were eligible. CLD was defined as persistent transaminitis for ≥ 60 days due to suspected or known primary hepatic dysfunction. Patients with conditions that may affect the measurement of leg muscles were excluded. US of the rectus femoris muscle was performed in triplicate for three US parameters: cross-sectional area (CSA), muscle thickness (MT) and echogenic intensity (EI). Fascicle length (FL) was calculated using trigonometry. Reliability was reported using intraclass correlation coefficients (ICCs) estimated from two-way mixed effects model for absolute agreement and means values compared by CLD vs healthy groups using logistic regression. Pearson correlation coefficient evaluated the relationship between BMI z-score and each muscle measure. Linear regression was used to examine the association of muscle measures with PELD/MELD.

Results: Of 156 patients recruited (N=69 (44.2%) CLD; 54.5% female; median age 6 years (IQR 2.23-11.24). Reliability was excellent (ICC >0.9) for averaged CSA, MT, EI and good (0.75-0.9) for FL. BMI z-score was correlated with CSA and MT (r=0.28 and 0.33, respectively, all p< 0.001), but not EI (r=-0.03, p=0.71). In multivariable regression adjusting for sex and age, muscle measurements were independently associated with CLD status (all p< 0.05, Table 1). Amongst CLD participants, CSA, height-adjusted CSA, MT, EI and FL were associated with PELD/MELD score, with these muscle measures accounting for 34-46% of the variability (all p< 0.05, R²=0.341-0.459).

Discussion: Ultrasound assessment of rectus femoris muscle is feasible and correlates with BMI z-score. These muscle measures significantly differ between CLD vs healthy pediatric participants and amongst those with CLD correlates with PELD/MELD score suggesting this is a novel tool for assessing sarcopenia. This pilot study strongly supports further study of sarcopenia by US in children.

	T-test				Multivariable Logistic Regression Model*
	Total (N=156) Mean (SD)	Healthy (N=87) Mean (SD)	Liver Disease (N=69) Mean (SD)	p-value	OR (LCL - UCL)	p-value
Muscle Measure
Right CSA (mm²)	347 (211)	345 (197)	350 (229)	0.89	1 (1.00-1.00)	0.09
Left CSA (mm²)	344 (207)	344 (196)	344 (222)	0.99	0.997 (0.99-1.00)	0.06
Right CSA/Ht²(mm^2/cm²)	0.024 (0.007)	0.025 (0.006)	0.023 (0.007)	0.08	---	---
Left CSA/Ht2 (mm^2/cm²)	0.025 (0.007)	0.025 (0.006)	0.023 (0.007)	0.08	---	---
Right MT (mm)	10.6 (3.5)	10.8 (3.3)	10.3 (3.9)	0.46	0.82 (0.71-0.96)	0.01
Left MT (mm)	10.5 (3.5)	10.7 (3.1)	10.2 (3.9)	0.35	0.82 (0.71-0.94)	0.006
Right EI (gray)	60 (10.5)	58.1 (9.0)	62.3 (11.8)	0.01	1.04 (1.01-1.08)	0.02
Left EI (gray)	59 (10.5)	57.4 (8.9)	60.9 (12.1)	0.04	1.04 (1.00-1.07)	0.05
Right FL (mm)	60.2 (31.6)	63.7 (34.7)	55.8 (26.7)	0.12	0.99 (0.97-0.99)	0.04
Left FL (mm)	60.9 (30.3)	64.4 (33.1)	56.4 (25.9)	0.1	0.98 (0.97-0.99)	0.02

Table: Title: T-test and Multivariable Logistic Regression Model for Liver Disease

Caption: Echogenic intensity and height-adjusted cross-sectional area are significantly different in CLD patients compared to healthy controls. In multivariable logistic regression, muscle measurements differed for CLD vs healthy participants in MT, EI and FL after adjusting for sex and age group, but were not associated in CSA.

CSA = Cross-Sectional Area
MT = Muscle Thickness
EI = Echogenic Intensity
FL = Fascicle Length

Footnote: *Multivariable models adjusted for sex and age group

Disclosures:

Christopher Chu indicated no relevant financial relationships.

Patricia Acharya indicated no relevant financial relationships.

David Rigual indicated no relevant financial relationships.

Jennifer Dodge indicated no relevant financial relationships.

Norah Terrault indicated no relevant financial relationships.

Christopher Chu, MD¹, Patricia Acharya, MD¹, David Rigual, MD¹, Jennifer L. Dodge, MPH², Norah Terrault, MD, MPH³. P1184 - Muscular Ultrasonography of the Rectus Femoris Muscle to Evaluate for Sarcopenia is Correlated With PELD/MELD Score in Children, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.