Sarcopenia Is Associated With Mortality and Progression of Cirrhosis in Decompensated but Not Compensated Disease—A Multicentre Study

BACKGROUND: Sarcopenia is associated with increased mortality in patients awaiting liver transplant (LT), but the impact of sarcopenia on cirrhosis progression remains under-evaluated. AIMS: We aimed to explore the relationship between sarcopenia and the risk of cirrhosis progression, mortality and hospitalisation in compensated and decompensated cirrhosis. METHODS: Sarcopenia was measured using the skeletal muscle index (SMI) obtained from abdominal CT imaging at the 3rd lumbar vertebra (L3). Progression of cirrhosis was defined by an increase in clinical stage from baseline using the D'Amico classification. Factors associated with progression or death, death alone and hospitalisation were evaluated with univariate and multivariate Cox regression models. RESULTS: One thousand six hundred and twenty-four adult patients with cirrhosis from five centres across Europe, North America and Asia were included. Mean age was 54 ± 9 years, 26% of patients were female, 31% had compensated disease and mean MELD-Na was 15 ± 7. With separate analyses for compensated and decompensated cirrhosis, sarcopenia was independently associated with the risk of progression or death (aHR 1.43, 95% CI 1.14-1.79, p = 0.002) and death alone (aHR 1.55, 95% CI 1.19-2.03, p = 0.001) only in decompensated cirrhosis. Sarcopenia was independently associated with unplanned hospitalisation in both compensated (aHR 1.70, 95% CI 1-15-2.51, p = 0.010) and decompensated cirrhosis (aHR 1.32, 95% CI 1.08-1.63, p = 0.007). CONCLUSIONS: Sarcopenia was independently associated with cirrhosis progression or death and death alone in decompensated cirrhosis. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing sarcopenia.