Sarcopenia as a prognostic indicator of liver cirrhosis

[...]to deaths during the compensated stage, which are largely due to cardiovascular disease, malignancy, and renal disease, deaths during the decompensated stage result from hepatic and extrahepatic organ failure. 1 The clinical course of LC is not linear but punctuated with episode(s) of acute deterioration (called AD, acute decompensation). [...]low physical performance is considered a predictor for poor outcomes; thus, such measures are useful to classify the severity of sarcopenia. 4 In patients with LC, factors contributing to sarcopenia in an interrelated manner could be categorized as (1) malnutrition (including inadequate intake and uptake; a state of ‘accelerated starvation’), (2) cirrhosis-related (including synthetic dysfunction; hyperammonaemia, which is myotoxic; anabolic resistance), (3) other systems-related (including systemic inflammation; gut dysbiosis and altered gut permeability; metabolic dysregulation), (4) physical inactivity, and (5) environmental/organizational factors. 6 Unlike the geriatric literature, computed tomography (CT) imaging is currently the gold standard for the assessment of muscle mass in cirrhosis. 6,7 When abdominal CT imaging is performed for clinical reasons, muscle mass measurement can be obtained using quantitative morphomics software as the skeletal muscle mass (SMI) at the third lumbar vertebra (L3). In a Canadian study of 669 cirrhotic patients who were evaluated for LT, Montano-Loza et al. reported that the modification of MELD to include sarcopenia (MELD-sarcopenia) is associated with an improvement in the prediction of mortality in patients with cirrhosis, and the observed benefit of modifying MELD to include sarcopenia was greatest in patients with low MELD scores, who are traditionally deemed to have a low risk of death. 15 Similarly, in a Korean study, although cirrhotic patients with sarcopenia had higher MELD scores, sarcopenia was associated with mortality in compensated and early decompensated cirrhosis. 16 Kang et al. showed that the impact of sarcopenia was stronger in patients with low MELD scores (MELD score < 15), Child–Pugh class A/B, and hepatic venous pressure gradient (HVPG) < 20 mmHg. In a recent study of US veterans, Shah et al. demonstrated that frailty increases the likelihood of ACLF hospitalization among patients with cirrhosis, but it does not impact short-term ACLF mortality. 18 These findings may be because once ACLF has been triggered, the most critical factor might be organ dys