Liver and Bile
J Hepatol. 2022;76(3):588–99
Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis
Background and aims: The association between sarcopenia and prognosis in patients with cirrhosis remains to be determined. In this study, the authors 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.
Methods: PubMed, Web of Science, Embase, and major scientific conference sessions were searched without language restriction through January 13, 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.
Results: 22 studies involving 6965 patients with cirrhosis were included. The pooled prevalence of sarcopenia in patients with cirrhosis was 37.5% overall (95% confidence interval [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 these analyses.
Conclusions: Sarcopenia was highly and independently associated with higher risk of mortality in patients with cirrhosis.