Imaging-based assessment of sarcopenia in liver transplant candidates: A systematic review

Table 2 Association between sarcopenia and waitlist mortality in end-stage liver disease: Summary of prevalence rates, effect measures, and outcomes from studies evaluating the impact of sarcopenia on waitlist mortality among patients with end-stage liver disease

Ref.	Prevalence of sarcopenia	Association with waitlist mortality	Effect measure	Result
Carey et al[25], 2017	45%, 42% male and 54% female	Significant	HR	HR per 1 cm2/m2 increase = 0.95 (95%CI: 0.92-0.98), P < 0.001, meaning a 5% risk reduction per unit increase in SMI; lower SMI indicates higher mortality risk
Sinclair et al[29], 2019	30, 9%	Significant	HR	HR per 1 kg/m2 increase in ALMI = 0.78 (95%CI: 0.62-0.98), P = 0.03. Indicates a 22% reduction in waitlist mortality risk with each unit increase in ALMI; sarcopenia is associated with increased risk
Kappus et al[30], 2020	17, 2%	Not significant	HR	HR = 0.98 (95%CI: 0.95-1.02), P = 0.41. No significant association between sarcopenia and waitlist mortality
Ebadi et al[34], 2018	22% (PMI-defined); 51% male/36% female (SMI)	Female: Both low SMI and PMI significant; male: Low SMI significant and PMI not significant	HR	Sarcopenia defined by SMI was significantly associated with increased waitlist mortality in both male (HR = 2.46, 95%CI: 1.38-4.39; P = 0.002) and female (HR = 2.05, 95%CI: 1.00-4.21; P = 0.05). Sarcopenia defined by PMI was significantly associated with mortality in females (HR = 2.47; 95%CI: 1.24-4.95; P = 0.01), but not in males (HR = 0.85; P = 0.09)
Alconchel et al[35], 2020	Not reported	Not significant	Not reported/no significant association	PMI was not representative of sarcopenia and failed to predict waitlist mortality

PMI: Psoas muscle index; SMI: Skeletal muscle index; HR: Hazard ratio; CI: Confidence interval; ALMI: Appendicular lean mass index.