Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7637-7647
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7637
Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score
Hee Yeon Kim, Jeong Won Jang
Hee Yeon Kim, Jeong Won Jang, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Kim HY and Jang JW contributed to this paper equally.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeong Won Jang, MD, PhD, Division of Hepatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. garden@catholic.ac.kr
Telephone: +82-2-22586015 Fax: +82-2-34814028
Received: January 26, 2015
Peer-review started: January 27, 2015
First decision: March 10, 2015
Revised: March 20, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: July 7, 2015

Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research.

Keywords: Liver cirrhosis, Model for end-stage liver diseases score, Mortality, Prognosis, Sarcopenia

Core tip: Sarcopenia is one of the most common complications associated with survival in cirrhotic patients. However, the lack of an objective and reliable method to quantify muscle mass has limited the general incorporation of sarcopenia into cirrhosis prognostic scores. In this article, we highlight cross-sectional imaging-based estimation of skeletal muscle mass for diagnosing sarcopenia and assessing the prognosis of cirrhosis patients. In addition, we explore the possibility of incorporating sarcopenia into conventional prognostic scoring systems for better prognostication in cirrhosis patients.