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In this study, we aimed to illustrate the clinical prognostic value of myosteatosis (muscle fat infiltration) for short-term mortality in patients with ACLF. We retrospectively enrolled consecutive patients with ACLF between January 2019 and January 2022. Computed tomography-based body composition analysis was performed at the third lumbar vertebral level to determine skeletal muscle radiation attenuation. Fine and Gray\u2019s competing risk regression model, with liver transplantation as a competing risk, was used to assess the factors associated with 90-day mortality. A total of 431 patients with ACLF were included. Myosteatosis and sarcopenia were observed in 261 (60.6%) and 87 (20.2%) patients, respectively. Competitive risk regression showed that age (HR 1.021, 95% CI 1.000\u20131.043, <jats:italic>P<\/jats:italic>\u2009=\u20090.042), APASL ACLF Research Consortium (AARC) score (HR 1.498, 95% CI 1.312\u20131.710, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and sarcopenia (HR 1.802, 95% CI 1.062\u20133.060, <jats:italic>P<\/jats:italic>\u2009=\u20090.029) were independently associated with increased 90-day mortality. Subgroup analysis of male patients with HBV-ACLF revealed that myosteatosis (HR 2.119, 95% CI 1.101\u20134.078, <jats:italic>P<\/jats:italic>\u2009=\u20090.025) was promising prognostic factors for 90-day mortality after being adjusted for ascites, acute kidney injury, AARC score, and sarcopenia. Myosteatosis is predictive of short-term outcomes in male patients with HBV-ACLF. Our results emphasise the importance of focusing on muscle fat infiltration in patients with HBV-ACLF. Further studies are warranted to investigate the underlying mechanisms and potential therapies for myosteatosis.\n<\/jats:p>","DOI":"10.1038\/s41598-024-64420-x","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T06:01:57Z","timestamp":1718258517000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Association of myosteatosis with short-term outcomes in patients with acute-on-chronic liver failure"],"prefix":"10.1038","volume":"14","author":[{"given":"Nan","family":"Geng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Kong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiateng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huina","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manman","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenyan","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongping","family":"Duan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"issue":"4","key":"64420_CR1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/ageing\/afq034","volume":"39","author":"AJ Cruz-Jentoft","year":"2010","unstructured":"Cruz-Jentoft, A. 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