Abstract
BackgroundSarcopenia is a common syndrome in chronic diseases such as liver cirrhosis. The association between sarcopenia and outcomes, such as complications and survival has recently been described in various patient groups. However, study results remain inconclusive. Therefore, the aim of this study was to systematically review the impact of sarcopenia on outcome in patients with cirrhosis.Methods and findingsWe conducted a systematic review (SR) and meta-analysis (MA) on the impact of sarcopenia on outcome in liver cirrhosis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Of the 312 studies identified, 20 were eligible according to our inclusion criteria. Most of the studies used CT to diagnose sarcopenia. Two studies used bioelectrical impedance analysis (BIA), 10 studies used skeletal muscle index (SMI) and 8 studies used total psoas muscle area (TPA). Seven studies included Asian participants and the remaining 13 studies included Western participants. The prevalence rate of sarcopenia among participants was mean 48.1%, and appeared more among men with a rate of 61.6% whereas the rate was 36% for women. With respect to clinical outcomes, patients with sarcopenia had poorer survival rates and an increased risk of complications such as infection compared to those without sarcopenia. According to the analysis of race subgroup, Asians had a HR 2.45 (95% confidence interval (CI) = 1.44–4.16, P = 0.001) of mortality whereas Westerners had a HR 1.45 (95% CI = 1.002–2.09, P<0.05).ConclusionsBased on this SR and MA, the presence of sarcopenia is related to a poor prognosis and occurrence of cirrhotic complications and could be used for risk assessment. Moreover, Asian participants had higher mortality related to sarcopenia compared to the Western participants.
Highlights
Cirrhosis is a leading cause of mortality worldwide, and it is associated with a significant reduction in health-related quality of life. [1,2] The ultimate therapy for liver cirrhosis is liver transplantation (LT). [3,4,5] Predicting the evolution of liver cirrhosis to improve therapeutic decision is a challenge, especially for patients who can obtain a donor liver because it is resource-spending
Based on this systematic review (SR) and MA, the presence of sarcopenia is related to a poor prognosis and occurrence of cirrhotic complications and could be used for risk assessment
Asian participants had higher mortality related to sarcopenia compared to the Western participants
Summary
Cirrhosis is a leading cause of mortality worldwide, and it is associated with a significant reduction in health-related quality of life. [1,2] The ultimate therapy for liver cirrhosis is liver transplantation (LT). [3,4,5] Predicting the evolution of liver cirrhosis to improve therapeutic decision is a challenge, especially for patients who can obtain a donor liver because it is resource-spending. The Child-Turcotte-Pugh (CTP) score and the Model for End Stage Liver Disease (MELD) scores are known as the best tools for predicting mortality in patients with cirrhosis. [9] In such patients, sarcopenia reflects protein–energy malnutrition, and contains appeal as a method to assess the nutritional status of the patient because of its quantitative, objective and simple methods. It has emerged as an independent predictor of poor prognosis in a variety of clinical conditions. [10,11] it is not always clear whether these consequences were determined from longitudinal studies or from cross-sectional studies It appears that the consequences can vary according to the definition of sarcopenia. The aim of this study was to systematically review the impact of sarcopenia on outcome in patients with cirrhosis
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