Clinical impact of sarcopenia assessment in patients with liver cirrhosis

ABSTRACT

Introduction: Sarcopenia is defined as loss of skeletal muscle mass, strength, and function, and it is associated with increased morbidity and mortality in patients with chronic liver disease.

Areas covered: The aim of this review is to provide a detailed report on the pathophysiological mechanisms underlying sarcopenia in cirrhotic patients, the several imaging methods available for the assessment of sarcopenia and the clinical studies evaluating the prognostic role of sarcopenia presence in cirrhotic patients.

Expert opinion: Sarcopenia pathogenesis is complex and multifaceted, as chronic catabolic conditions, increased energy expenditure, reduced appetite, side effects of multiple therapies, alterations in circulating levels of hormones, low protein synthesis, presence of ascites or portosystemic shunts are all factors contributing to muscle atrophy in cirrhotic patients. Computed tomography scan is the most validated method to evaluate muscle mass and quality. Sarcopenia is associated with a higher rate waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis. Future studies should make an effort to unify and validate liver disease-specific cutoffs for the definition of sarcopenia.

KEYWORDS:

• Skeletal muscle mass
• body composition
• malnutrition
• chronic liver disease
• liver transplantation

Abbreviations

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Article highlights

• Sarcopenia is defined as loss of skeletal muscle mass, strength, and/or function.

• The assessment of the body composition by computed tomography scan represents the most validated method to evaluate muscle mass and quality.

• The presence of sarcopenia is associated with increased morbidity and waitlist mortality in patients with liver cirrhosis.

• Future studies should make an effort to unify and validate liver disease-specific cut-offs for the definition of sarcopenia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.