The Effect of Loop Diuretics on Sarcopenia and Long-Term Prognosis in Patients with Refractory Hepatic Ascites Treated with Tolvaptan

Abstract

Background and Aim: We aimed to determine whether sarcopenia was associated with the dose of furosemide in patients with refractory hepatic ascites treated with tolvaptan. Methods: We retrospectively studied data of 70 patients with refractory hepatic ascites treated with tolvaptan between April 2011 and April 2017. Body weight of patients was measured, and they were defined as responders if their body weight decreased ≥ 1.5 kg in 1 week. Psoas muscle index (PMI) at the level of the third lumbar vertebra was measured by computed tomography, and sarcopenia was evaluated by PMI (cut-off value: 6.36 cm2/m2 in men and 3.92 cm2/m2 in women). The dose of furosemide was defined as low-dose: ≤ 20 mg/day and highdose: over 20 mg/day. Long-term prognosis was evaluated after tolvaptan administration. Results: The frequency of use of high-dose furosemide was 60%. Tolvaptan treatment responders accounted for 64.8% of the patients. The frequency of sarcopenia was 90% of all patients. A statistically significant difference was observed in PMI between the low-dose (3.63 ± 1.16 cm2/m2) and high-dose use of furosemide (3.06 ± 1.17 cm2/ m2) before tolvaptan treatment (p = 0.048). The PMI increased from 3.02 ± 0.96 to 3.49 ± 1.14 cm2/m2 (p < 0.001) in responders but reduced from 3.09 ± 0.94 to 2.86 ± 0.89 cm2/m2 (p = 0.114) in non-responders before and after tolvaptan treatment. The long-term prognosis improved in responders compared with non-responders (mean survival time: 546 days vs. 203 days, p < 0.001). Conclusion: The frequency of sarcopenia was high in refractory hepatic ascites treated with high-dose furosemide before tolvaptan treatment. As expected, improvement in sarcopenia and longterm prognosis occurred in responders. Therefore, early introduction of tolvaptan treatment is necessary.