Impact of Sarcopenia on Survival and Clinical Outcomes in Patients With Liver Cirrhosis

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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.

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Sarcopenia: revised European consensus on definition and diagnosis

Alfonso Cruz-Jentoft, Gulistan Bahat, Jürgen Bauer … (2018)

Abstract Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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EASL Clinical Practice Guidelines on nutrition in chronic liver disease

Manuela Merli, Annalisa Berzigotti, Shira Zelber-Sagi … (2019)

A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including infections, hepatic encephalopathy and ascites. In recent years, the rising prevalence of obesity has led to an increase in the number of cirrhosis cases related to non-alcoholic steatohepatitis. Malnutrition, obesity and sarcopenic obesity may worsen the prognosis of patients with liver cirrhosis and lower their survival. Nutritional monitoring and intervention is therefore crucial in chronic liver disease. These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients.

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Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Gaeun Kim, Seong Kang, Moon Kim … (2017)

Background Sarcopenia 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 findings We 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). Conclusions Based 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.

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Mirabela-Madalina Topan: URI : http://loop.frontiersin.org/people/1486102/overview

Ioan Sporea: URI : http://loop.frontiersin.org/people/1256582/overview

Mirela Dănilă: URI : http://loop.frontiersin.org/people/1458785/overview

Ana-Maria Ghiuchici: URI : http://loop.frontiersin.org/people/1485643/overview

Raluca Lupuşoru: URI : http://loop.frontiersin.org/people/1421106/overview

Roxana Şirli: URI : http://loop.frontiersin.org/people/1121410/overview

Journal

Journal ID (nlm-ta): Front Nutr

Journal ID (iso-abbrev): Front Nutr

Journal ID (publisher-id): Front. Nutr.

Title: Frontiers in Nutrition

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-861X

Publication date (Electronic): 21 October 2021

Publication date Collection: 2021

Volume: 8

Electronic Location Identifier: 766451

Affiliations

[1] ¹Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy , Timişoara, Romania

[2] ²Advanced Regional Research Center in Gastroenterology and Hepatology of the “Victor Babeş” University of Medicine and Pharmacy , Timişoara, Romania

[3] ³Department of Functional Science, Center for Modeling Biological Systems and Data Analysis, University of Medicine and Pharmacy Victor Babeş , Timişoara, Romania

Author notes

Edited by: Speranta Iacob, Fundeni Clinical Institute, Romania

Reviewed by: Zhiyong Huang, Huazhong University of Science and Technology, China; Eugen Dumitru, Ovidius University, Romania; Mihai Mircea Diculescu, Carol Davila University of Medicine and Pharmacy, Romania

*Correspondence: Mirela Dănilă danila.mirela@ 123456umft.ro

This article was submitted to Clinical Nutrition, a section of the journal Frontiers in Nutrition

Article

DOI: 10.3389/fnut.2021.766451

PMC ID: 8566695

PubMed ID: 34746216

SO-VID: d4b29c16-09b7-48c5-9179-b5eab4bd85d6

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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 29 August 2021

Date accepted : 27 September 2021

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Figures: 0, Tables: 5, Equations: 0, References: 20, Pages: 6, Words: 4126

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Impact of Sarcopenia on Survival and Clinical Outcomes in Patients With Liver Cirrhosis

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Most cited references 20

Sarcopenia: revised European consensus on definition and diagnosis

EASL Clinical Practice Guidelines on nutrition in chronic liver disease

Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

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