S1309 Can Sarcopenia Diagnosed by Hand Grip Strength Provide a Better MELD-Na Cutoff in Predicting Complications of Cirrhosis?

Abstract

Introduction: Computerized Tomography (CT) measured Skeletal Muscle Index (SMI) is the best investigation to diagnose sarcopenia. However, in developing countries, it is not feasible due to cost and unavailability. Hand grip strength using hand grip dynamometry is a simple, economical and repeaTable bedside tool to assess sarcopenia in cirrhotics. MELD-Na score is a better marker for short term mortality and transplant allocation rather than predicting decompensation events in cirrhotics. In the present study, we showed that hand grip strength with MELD-Na score can correlate with complications of cirrhosis and predict survival. Methods: A total of 72 patients between December 2019 and June 2021 diagnosed with liver cirrhosis on the basis of imaging were included in our study. Hand grip strength was measured by hand grip dynamometer in the non-dominant hand in sitting position with semi-flexed arm. Mean of three values was taken as final reading. Cut-offs of < 26 kg for men and < 18 kg for women were taken from Asian Working Group for Sarcopenia 2014 consensus. Patients were followed up for a period of 6 months. Results: In our study, the prevalence of sarcopenia was 83.3%. The mean MELD-Na score was 20. Presence of sarcopenia correlated with complications like bleeding esophageal varices (p = 0.01), Hepatic Encephalopathy (HE) (p = 0.002) and Hepatorenal Syndrome (HRS) (p = 0.006). On univariate analysis, when MELD-Na was > 20.5, sarcopenia was significantly associated with HE [Odd’s Ratio (OR), 9.33; 95% confidence interval (CI), 1.86 - 46.68; p = 0.007], bleeding esophageal varices [OR, 4.29; 95% CI, 1.35 - 13.58; p = 0.01] and HRS [OR, 12.43; 95% CI, 1.46 -105.74; p = 0.02]. The MELD-Na score of more than 20.5 with sarcopenia predicted mortality with sensitivity 100%, specificity 65% and p = 0.038. The estimated survival of sarcopenics at 6 months with MELD-Na > 20.5 was 83.3%. Conclusion: Hand grip strength is a simple, non-expensive test to diagnose sarcopenia. In resource limited countries, it can be used instead of CT scan measured SMI. As a measure of sarcopenia, it shows a statistically significant association with decompensation events of cirrhosis. In patients not yet listed for transplant, hand grip strength measured sarcopenia along with MELD-Na score cut-off of 20.5 can be utilized to optimize medical treatment, to prevent decompensation, recurrent hospitalization and ensure good quality of life.