Xinxing Tantai, Yi Liu, Yee Hui Yeo, Michael Praktiknjo, Ezequiel Mauro, Yuhei Hamaguchi, Cornelius Engelmann, Peng Zhang, Jae Yoon Jeong, Jeroen Laurens Ad van Vugt, Huijuan Xiao, Huan Deng, Xu Gao, Qing Ye, Jiayuan Zhang, Longbao Yang, Yaqin Cai, Yixin Liu, Na Liu, Zongfang Li, Tao Han, Toshimi Kaido, Joo Hyun Sohn, Christian Strassburg, Thomas Berg, Jonel Trebicka, Yao-Chun Hsu, Jan Nicolaas Maria IJzermans, Jinhai Wang, Grace L. Su, Fanpu Ji and Mindie H. Nguyen
Background & Aims
The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, we aimed to quantify the association between sarcopenia and the risk of mortality in patients with cirrhosis, stratified by sex, underlying liver disease etiology, and severity of hepatic dysfunction.
PubMed, Web of Science, EMBASE, and major scientific conference sessions were searched without language restriction through 13 January 2021 with an additional manual search of bibliographies of relevant articles. Cohort studies of ≥100 patients with cirrhosis and ≥12 months of follow-up that evaluated the association between sarcopenia, muscle mass and the risk of mortality were included.
Twenty-two studies involving 6,965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% CI 32.4%-42.8%), and was higher in male patients, those with alcohol-associated liver disease, those with Child-Pugh grade C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index). Sarcopenia was associated with an increased risk of mortality in patients with cirrhosis (adjusted hazard ratio [aHR] 2.30, 95% CI 2.01-2.63), with similar findings in a sensitivity analysis of patients with cirrhosis without hepatocellular carcinoma (aHR 2.35, 95% CI 1.95-2.83) and in subgroups stratified by sex, liver disease etiology, and severity of hepatic dysfunction. The association between quantitative muscle mass index and mortality further supports the association between sarcopenia and poor prognosis (aHR 0.95, 95% CI 0.93-0.98). There was no significant heterogeneity in any of our analyses.
Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis.