Sarcopenia as a Predictor of Mortality and Complications in Cirrhosis Patients-A Prospective Cohort Study

<i>Background: </i>Sarcopenia has emerged as an important prognostic factor in cirrhosis patients. A standardized definition of sarcopenia was not used in many of the studies. EWGSOP2 2019 guidelines define sarcopenia in an objective manner. Ultrasound-guided measurement of thigh muscle thickness is a validated and cost effective tool for the assessment of muscle quantity. Aim of the study was to evaluate the predictive role of sarcopenia on mortality and complications in cirrhosis patients.<i> Methods: </i>It was a prospective cohort study with 143 consecutive patients each in sarcopenia and no sarcopenia groups. Sarcopenia was diagnosed as per EWGSOP2 guidelines incorporating ultrasound-guided thigh muscle thickness measurement. They were studied at 6 months for development of complications and mortality. Kaplan-Meier analysis was used to compare survival and Cox proportional hazards model was used to determine risk factors of mortality.<i> Results: </i>Cirrhosis patients with sarcopenia [M:F=97:46] and without sarcopenia [M:F=111:32] were followed up for 6 months. Survival analysis showed a six-month cumulative survival of 58.0% (95%CI 57.92-58.08) and 76.2% (95% CI 76.13-76.27) in sarcopenia and no sarcopenia groups respectively (p-value 0.001). Six-month cumulative survival in patients with severe sarcopenia was 23.8% and in non-severe sarcopenia was 70.1% (p-value 0.001). Multivariate analysis showed sarcopenia (HR=1.498,95%CI 1.081-2.148), female sex (HR=1.86,95%CI 1.102-3.089), Child Pugh class C (HR=1.458,95%CI 1.214-1.775) and MELD-Na score>15 (HR=1.122,95%CI 1.068-2.212) as independent predictors of mortality. Complications like ascites, HE, Covid 19 infection and UGI bleed were significantly higher in the sarcopenia group.<i> Conclusion: </i>Sarcopenia is an independent prognostic marker of mortality in cirrhosis patients and is associated with an increased risk of complications. Severe sarcopenia has even poorer outcome.