Abstract
Background: Sarcopenia is now recognized more and more as a biomarker with poor outcomes in cirrhotic patients.Aims: The purpose of this study was to investigate the prevalence of sarcopenia in patients with liver cirrhosis and prospectively investigate the association between sarcopenia and different complications and its impact on survival.Material and Methods: This prospective study included patients with liver cirrhosis admitted to our department from 2018 to 2020. Sarcopenia was assessed according to EWGSOP2 criteria, incorporating low Handgrip strength (<27 kg for men and <16 kg for women) with low skeletal muscle index evaluated by CT (<50 for men and <39 for women). Associations between sarcopenia and portal hypertension-related complications, infectious complications, and risk of hepatocellular carcinoma, the number of in-hospital days, 30-day readmission, and survival over the next 6 and 12 months were analyzed.Results: A total of 201 patients were enrolled in the study, 63.2% male, mean age 61.65 ± 9.49 years, 79.6% Child-Pugh class B and C. The primary etiology of liver cirrhosis was alcohol consumption (55.2%). The prevalence of sarcopenia was 57.2 %, with no significant differences between the male and female groups. Significant associations were found between sarcopenia and portal hypertension-related complications, infectious complications, and risk of hepatocellular carcinoma. In multivariate analysis, sarcopenia was assessed as a risk factor alone, increasing the risk for ascites 3.78 times, hepatocellular carcinoma by 9.23 times, urinary tract infection by 4.83 times, and spontaneous peritonitis 2.49 times. Sarcopenia was associated with more extended hospital stay and higher 30 days readmission. Six months and 1-year survival were reduced in the sarcopenia group than in the non-sarcopenia group (p < 0.0001).Conclusion: Sarcopenia is a common complication of liver cirrhosis and associates with adverse health-related outcomes and poor survival rates.
Highlights
During the last years, various scientific groups attempted to develop different definitions for sarcopenia
Significant associations were found between sarcopenia and portal hypertension-related complications, infectious complications, and risk of hepatocellular carcinoma
Sarcopenia was assessed as a risk factor alone, increasing the risk for ascites 3.78 times, hepatocellular carcinoma by 9.23 times, urinary tract infection by 4.83 times, and spontaneous peritonitis 2.49 times
Summary
Various scientific groups attempted to develop different definitions for sarcopenia. The European Working Group on Sarcopenia in Older People (EWGSOP2) [1] updated in 2019 their previous definition of sarcopenia, which is defined as a muscle disease (low muscle quantity and quality) associated with low muscle strength. Liver cirrhosis is one of the most representative chronic diseases, which can be complicated by sarcopenia. The prevalence of sarcopenia in Liver Cirrhosis is around 23–60% [4], but this percentage depends on the severity of the underlying liver disease and the diagnostic tools and criteria utilized. Previous studies have evaluated the association between sarcopenia and higher rates of other cirrhosis complications, infections, hospital admissions, and reduced survival [5,6,7,8], but few of those studies applied the new EWGSOP2 criteria to define sarcopenia. Sarcopenia is recognized more and more as a biomarker with poor outcomes in cirrhotic patients
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