Muscle strength and physical performance, rather than muscle mass, correlate with mortality in end-stage liver disease

Abstract

Objectives Sarcopenia is characterized by the loss of skeletal muscle mass, strength and performance. The study aimed to provide cut off values of various Sarcopenia parameters [computerized tomography skeletal muscle index (SMI), handgrip strength (HGS), gait velocity and chair stand] to predict mortality in end-stage liver disease (ESLD). Methods The inclusion criteria were age 18–75 years, model for end-stage liver disease > 15. All patients with advanced heart, lung, kidney diseases, active malignancy were excluded from the study. Sarcopenia indices were compared between survivors and non-survivors to find cut off value for prediction of mortality in ESLD patients. Results One hundred sixty-one subjects suffering from ESLD were enrolled. The cutoff value of the SMI to identify high risk of mortality in sarcopenia patients is ≤21.2 cm2/m2, area under the curve (AUC) 0.537 [95% confidence interval (CI) 0.456–0.616]. The cutoff value of the hand grip strength to identify high-risk mortality is ≤25.3 kilogram-force, AUC 0.682 (95% CI 0.604–0.753). The cutoff value of the gait velocity for the same is as ≤0.84 m/s, AUC 0.551 (95% CI 0.459–0.641). The cutoff value of the chair stand is ≥20.9 seconds, AUC 0.956 (95% CI 0.910–0.983). In the multivariate analysis, HGS, gait velocity and chair stand correlated with mortality. Conclusion The current study is a comprehensive Asian study that gives the cut off values of Sarcopenia: muscle mass, strength and performance which identify high risk of mortality in ESLD patients. Muscle strength and performance correlated with mortality.

Definition of Sarcopenia in Chronic Liver Disease

“…The chair stand test in patients with CLD has been used as a parameter for frailty rather than sarcopenia [109][110][111]. The chair stand test was found to be an independent factor predictive of poor quality of life and waitlist mortality in patients with end-stage liver disease [110,112,113]. However, research on the usefulness of and appropriate cutoff values for the chair stand test in patients with CLD is still lacking.…”

Assessment of Sarcopenia in Chronic Liver Disease: Indian Perspective

“…Our results suggest that a combination of low HGS and low SMI is a better predictor of mortality in patients with cirrhosis compared with low SMI or low HGS alone. 11 Other studies from India have also shown that HSG correlates with mortality in patients with cirrhosis, 12 further validating the incorporation of low HGS in the diagnostic definition.…”

“…These include gait speed, chair stand, timed up and go test, short physical performance battery, and 400‐m walk test. The inability to perform these tests suggests severe sarcopenia, which correlates with poor outcomes in cirrhosis 12 . The INASL recommends a 4‐m usual walking gait speed of ≤0.8 m/s as an indicator of reduced physical performance.…”

Sarcopenia is Closely Associated With Frailty in Decompensated Cirrhosis

“…<0.001). Utilizing the recently derived Indian cutoffs for poor prognosis in cirrhotics7 , HGS≤ 25.3 kg force was noted in 53 (65%) patients and suboptimal chair-stand (≥ 20.9 seconds) was noted in 44 (54%)…”