Sarcopenia prevalence and its effect on prognosis in patients with liver cirrhosis

Objectives: In patients with sarcopenia, which has a high prevalence in liver cirrhosis, it increases other cirrhosis complications, reduces quality of life and survival, and adversely affects the prognosis after transplantation. In our study, it was aimed to determine the frequency of sarcopenia in patients with liver cirrhosis, to investigate the complications of cirrhosis and its relationship with prognosis of the disease. Material and Method: The study included 53 patients, 18 years of age or older, who had a follow-up in the Department of Gastroenterology, Dokuz Eylul University Hospital, diagnosed with liver cirrhosis (ICD code K74) between 01.01.2014 and 31.12.2019, and whose laboratory and imaging data were fully available. According to L3-SMI data obtained from abdomen computed tomography (CT) examinations, patients were divided into two groups as those with and without sarcopenia. The relationship of sarcopenia with determined demographic, clinical, laboratory findings, neutrophil-lymphocyte ratio, cirrhosis complications, prognosis and mortality were investigated. Results: The prevalence of sarcopenia was found to be 50.9% (27/53) according to L3-SMI calculated on the abdominal CT images of liver cirrhosis patients included in the study. It was observed that 70.4% (19/27) of the patients with sarcopenia were male. The rate of sarcopenia in males was statistically significantly higher than in females (p <0.05) . In the patient group with sarcopenia, body mass index (BMI), SMI (cm² / m²), albumin, serum sodium were statistically significantly lower (p <0.004, p = 0.005, p = 0.014, p = 0.010, respectively) ; bilirubin, INR, MELD-Na score and Child Pugh score were statistically significantly higher (p = 0.002, p = 0.005, p = 0.001, p = 0.007, respectively) compared to the non-sarcopenia patients. MELD-NA score ≥ 15 patients (48.14% 19.23%, p = 0.022) and the number of patients with Child-Pugh Score C were also statistically significantly higher in the group with sarcopenia than in the group without sarcopenia (33.3% to 7.7%, p = 0.026) . Patients with sarcopenia had higher rates of hepatic encephalopathy, acid, spontaneous bacterial peritonitis, esophageal and / or gastric varicose veins, variceal bleeding, portal vein thrombosis, hepatocellular carcinoma, but this difference was not statistically significant (p = 0.074, p = 0.125, p = 0.788, p = 0.941, p = 0.379, p = 0.268, p = 0.088); There was a statistically significant increase in favor of the group with sarcopenia in terms of jaundice (p = 0.041) . Although the mortality rate was higher in patients with sarcopenia, this difference was not statistically significant (p = 0.196) . Conclusion: In our study, sarcopenia, an important syndrome, has been shown to be highly prevalent in patients with liver cirrhosis and independent of body mass index. Especially male patients were found to be at risk for sarcopenia. The prognostic significance of sarcopenia, which is associated with jaundice and high Child-Pugh Score, high MELD-Na score, hyponatremia, hypoalbuminemia, has been demonstrated. In the literature, it has been one of the pioneering studies investigating the relationship between sarcopenia and neutrophil-lymphocyte ratio in patients with liver cirrhosis. Keyword: Cirrhosis, Sarcopenia, SMI