Retrospective evaluation of sarcopenia and investigation of prognostic value of sarcopenia using psoas muscle area on computed tomography in patients with liver cirrhosis

Purpose: We aimed to evaluate the frequency of sarcopenia in patients with cirrhosis, the correlation of laboratory values and conventional prognostic scores with sarcopenia, association with mortality and feature of predicting mortality. Materials and Methods: Between September 2012 and April 2014, 229 patients with cirrhosis diagnosed in our hospital who underwent abdominal computed tomography scans for hepatocellular carcinoma screening in our unit were included in the study. A control group was formed in 204 healthy individuals who had undergone abdominal computed tomography examination due to trauma in 2014 at the same hospital. Patient's file data scanned. 1 and 3-year follow-up results were recorded. Cross-sectional areas of the right and left psoas muscles were calculated in axial sections passing through the middle section of the L3 vertebra in the computed tomography images obtained from the study and control groups. The cases with 2 standard deviations below the mean of the total psoas muscle area of control group were evaluated as sarcopenic. Spearman correlation and ROC curve analysis were used for statistical analysis. Results: Sarcopenia was detected in 39.7% of 229 cirrhotic patients. The age of patients with sarcopenia was found significantly higher than patients without sarcopenia. There was no statistically significant difference between the patients with sarcopenic and non-sarcopenic cirrhosis according to sex and body mass index. The albumin and sodium values of patients with sarcopenia were significantly lower than patients without sarcopenia. When a statistically significant difference was detected in terms of Child-Pugh prognostic score between cirrhosis patients with and without sarcopenia; there was no significant difference in MELD score. The percentage of patients with sarcopenic cirrhosis who died after 1 and 3 years of follow-up (28.6% and 40.7%, respectively) were significantly higher than non-sarcopenic patients (9.4% and 24.6%, respectively). The psoas muscle area was determined to have a diagnostic decision-making ability in anticipation of the 1-year mortality, but not 3-year mortality. In addition, the survival rate of sarcopenic cirrhosis patients was found significantly lower than that of non-sarcopenic patients. Discussion: Sarcopenia is a powerful and independent predictor of mortality in cirrhosis. Liver transplantation is the only treatment for cirrhosis, but this is not possible in most patients. For this reason, the management of cirrhosis patients is usually focused on the prevention and control of complications. Early identification of sarcopenic patients and early intervention in treatment is important for long life expectancy, improvement in quality of life and reduction of complications.