Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

Abstract

Sarcopenia is associated with mortality in cirrhosis, but there is no gold standard for its diagnosis. The comparative utility of different diagnostic methods is unknown. This single‐center observational cohort study followed 145 men referred for liver transplant evaluation between 2005 and 2012. Muscle mass was estimated by handgrip strength, dual energy X‐ray absorptiometry (DEXA) lean mass, and single‐slice computed tomography (CT) scan at the fourth lumbar vertebra. Recorded outcomes included time to death or liver transplantation. The median (interquartile range [IQR]) age was 54 years (47‐59 years), and Model for End‐Stage Liver Disease (MELD) score was 17 (14‐23). Of 145 men, 56 died with a median (IQR) time to death of 7.44 months (3.48‐14.16 months). In total, 79 men underwent transplantation with median (IQR) time to transplant of 7.20 months (3.96‐12.84 months). The prevalence of sarcopenia differed between diagnostic modalities with 70.3% using CT muscle mass, 45.9% using handgrip strength, and 38.7% using DEXA. Muscle mass was inversely associated with wait‐list mortality for measured CT muscle mass (hazard ratio [HR], 0.94; 95% confidence interval (CI), 0.90‐0.98; P = 0.002), DEXA muscle mass (HR, 0.99; 95% CI, 0.99‐0.99; P = 0.003), and handgrip strength (HR, 0.94; 95% CI, 0.91‐0.98; P = 0.002). These results retained significance independent of the MELD score. In predicting mortality, the MELD–handgrip strength bivariate Cox model was superior to a MELD‐CT muscle Cox model (P < 0.001). In conclusion, handgrip strength combined with MELD score was the superior predictive model in this novel study examining 3 commonly employed techniques to diagnose sarcopenia in cirrhosis. Handgrip strength has additional potential clinical benefits because it can be performed serially without the radiation dose, cost, and access issues attributable to CT and DEXA.

Sarcopenia and Liver Cirrhosis—Comparison of the European Working Group on Sarcopenia Criteria 2010 and 2019

“…In this study, however, muscle mass was assessed using dual energy x-ray absorptiometry (DEXA), which might also be a reason for the discrepant results compared to liver cirrhosis [23]. Large differences in the prevalence of sarcopenia between CT scan (70.3%) and DEXA (38.7%) were also found in patients with chronic liver disease [24]. In chronic obstructive pulmonary disease, the prevalence of sarcopenia was not different between the two definitions (16.8% vs. 13.1%).…”

Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?

“…Contrary to the CST, the prognosis value of HGS has been demonstrated in many works in patients with cirrhosis. HGS is an independent factor of mortality [33,34], but weakly correlates with muscle mass and quality assessed on cross-sectional imaging [35]. These results imply that the complementarity of a quantification with a functional approach is needed.…”

“…Sinclair et al recently found a large difference in the prevalence of sarcopenia between CT (Computed Tomography) scan (70.3%) and DEXA (38.7%). DEXA underestimates the prevalence of sarcopenia in patients with fluid overload and cannot be used in patients with CLD [33].…”

“…A 15% increase in mortality risk per unit decrease in transversal psoas muscle thickness normalized to height was shown. By combining MELD and handgrip strength, a new model, the MELD-handgrip strength, was the most efficient score to predict waitlist mortality, better than a MELD-CT muscle score [33]. However, cautions must be taken with that kind of scores.…”

Handgrip Strength Adds More Prognostic Value to the Model for End‐Stage Liver Disease Score Than Imaging‐Based Measures of Muscle Mass in Men With Cirrhosis

“…We read the article by Sinclair et al (1) with great interest, and we sincerely congratulate them for highlighting the importance of sarcopenia in patients with cirrhosis. Notably, they wanted to show the prognostic value of different parameters related to sarcopenia.…”