Current management strategies for sarcopenia and frailty in cirrhosis: Missing link in transplant candidacy

Table 5 Clinical outcomes associated with sarcopenia in patients with cirrhosis

Ref.	Objectives	Methodology	Findings
Montano-Loza et al[160]	To evaluate the impact of sarcopenia in cirrhosis	669 cirrhotic patients using a novel MELD-sarcopenia score derived through Cox proportional hazards regression	Patients with sarcopenia had shorter median survival than non-sarcopenic patients (20 ± 3 months vs 95 ± 24 months, P < 0.001); MELD-sarcopenia score was associated with improved prediction of mortality
Bhanji et al[153]	To evaluate if sarcopenia is associated with overt hepatic encephalopathy in cirrhotics and evaluate its impact on mortality	675 cirrhotics with CT to evaluate sarcopenia	Sarcopenia was associated with an increased risk of hepatic encephalopathy (OR 2.42; 95%CI: 1.43-4.10, P = 0.001) and mortality (csHR 2.15, P < 0.001), independent of the MELD score
Zhou et al[168]	To investigate the association between sarcopenia and 1-year overall survival in patients with decompensated cirrhosis after liver transplantation	222 cirrhotics who underwent LT were followed up to compare and evaluate postoperative outcomes	Decompensated cirrhotics with sarcopenia had a longer ICU stay (4.1 ± 2.2 days vs 3.1 ± 1.1 days, P = 0.008), higher rate of major complications (45.2% vs 22.1%, P = 0.001), higher post-LT mortality (15.1% vs 2.9%, P = 0.003) with a shorter 1-year overall survival post-LT (P < 0.001), than in those without sarcopenia
Golse et al[166]	To evaluate the impact of sarcopenia on post-LT survival	256 patients with cirrhosis who underwent liver transplantation were selected retrospectively to study for post-LT survival	Significantly lower 1- and 5-year survival rates post-LT were reported in patients with sarcopenia (59% vs 94% and 54% vs 80%, respectively P < 0.001), compared to candidates without sarcopenia. (utilized the psoas muscle area as a measurement for sarcopenia, PMA was found to offer better accuracy than L3SMI)
Lai et al[154]	To develop a novel frailty index, encompassing extrahepatic complications of cirrhosis- muscle wasting, malnutrition and functional decline, as an improved mortality predictor in ESLD	536 cirrhotics (MELD-Na > 18) listed for LT. Final Frailty Index comprised of- grip strength, chair stands, and balance which were identified by best subset selection analyses with Cox regression to predict the waitlist mortality	Addition of Novel LFI to MELD score resulted in better prediction of waitlist mortality and has potential clinical utility to predict outcomes over a longer term on waitlist. Compared with MELD-Na alone, MELD-Na + Frailty Index correctly re-classified 16% of deaths/delistings (P = 0.005) and 3% of non-deaths/delistings (P = 0.17) with a total mortality of 19% (P < 0.001)

OR: Odds ratio; csHR: Cause-specific hazard ratio; MELD: Model for end-stage liver disease; ICU: Intensive care unit; LT: Liver transplant; LFI: Liver Frailty Index; CT: Computed tomography; ESLD: End-stage liver disease.