Bedside Tests of Muscle Function are Non-inferior to Skeletal Muscle Index in Predicting Outcomes in Patients with Cirrhosis and Correlate Better with Health-related Quality of Life and Cognitive Function

Abstract

Presenting Author: Dr. Surender Singh Background: Sarcopenia is an independent predictor of poor outcomes in patients with cirrhosis. Assessment of sarcopenia can be done either by Computer Tomography based skeletal muscle index (SMI) or bedside tests like Handgrip strength or Gait speed. Aims: To compare Handgrip strength and Gait-speed with SMI in predicting mortality and their correlation with Health-related quality of life (HRQOL) and cognitive function in cirrhosis. Methods: 116 outpatients with cirrhosis were included in this prospective cohort study. Assessment for sarcopenia was done by SMI, Handgrip strength and Gait speed and Receiver operative curves (ROC) curves were plotted to compare them as predictors of mortality. HRQOL was assessed using the chronic liver disease questionnaire (CLDQ) and fatigue severity scale (FSS). Cognitive function was assessed by mini-mental state examination (MMSE). Correlations of SMI with Handgrip strength, Gait speed, HRQOL, and cognitive function were analyzed. Results: 100(86.2%) males and 16(13.8%) females with a mean age of 50.2(48.4-51.9, 95%CI) years were included. The most common cause of cirrhosis was alcoholic liver disease (47.4%) followed by hepatitis C (12.9%). Sarcopenia was diagnosed in 64(55.2%) patients using SMI. The AUCs of Gait speed, Handgrip strength, and SMI in predicting mortality were 0.91(0.85- 0.96), 0.86(0.78-0.93), and 0.8(0.71-0.88) respectively (P >0.05). The CLDQ and MMSE scores were significantly lower in the sarcopenic group, whereas the FSS score was higher suggestive of poor HRQOL and cognitive function in comparison to the Not sarcopenic group. Significant correlation was seen between SMI and Handgrip strength (r=0.75) and Gait-speed (r=0.63), (P<0.01). CLDQ(r=0.86) and FSS(r=0.77) showed strongest correlation with Handgrip strength and MMSE with Gait-speed (r=0.71), (P<0.01). Conclusion: The Handgrip strength and Gait-speed are non-inferior to SMI as an independent predictor of mortality, and correlate better with HRQOL and cognitive function, and could replace SMI for assessment of sarcopenia.