Higher subcutaneous adipose tissue radiodensity is associated with an increased risk of the onset of Acute-on-Chronic Liver Failure

Background Body composition plays a significant role in the development and progression of disease in patients with acute decompensation of cirrhosis. Previous studies have identified the psoas muscle index (PMI) as an independent risk factor for predicting one-year mortality in patients with acute-on-chronic liver failure (ACLF). However, the relationship between adipose tissue, another component of body composition, and disease progression in patients with ACLF remains unclear. This study aimed to investigate the association between computed tomography (CT)-derived adipose tissue characteristics and the occurrence of ACLF and to develop a predictive model for ACLF. Methods This study included 343 adult patients with acute decompensation of cirrhosis who underwent abdominal CT examinations at our center between 2018 and 2022. Clinical laboratory test results and CT-derived adipose tissue characteristics were analyzed. Disease progression within 7 days was monitored, and a predictive model for ACLF occurrence incorporating adipose tissue information was developed. Results A total of 42 patients progressed to ACLF within 7 days. Significant differences in adipose tissue density were observed between the ACLF occurrence and non-occurrence groups. The subcutaneous adipose tissue (SAT) radiodensity in the ACLF occurrence group was − 75.79 (SD ± 16.35) HU, compared to -86.08 (SD ± 14.35) HU in the non-occurrence group. Ultimately, the predictive model comprising four variables—direct bilirubin (DBIL), prothrombin activity (PTA), sodium ion (NA+), and SAT radiodensity—demonstrated an area under the curve (AUC) of 0.93 and 0.91 in the training and test sets, respectively. Conclusions Patients with high SAT radiodensity are at a higher risk of developing ACLF. The newly established model can accurately identify individuals at higher risk of ACLF among patients with acute decompensation of cirrhosis, thereby facilitating early clinical intervention and improving patient survival rates.